Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
35 Cards in this Set
- Front
- Back
|
Describe the normal Blood Flow Through The Heart?
|
*Deoxygenated blood enters the right atrium
-->then to the right ventricle-->Then the pulmonary artery (this is the only artery in the body that carries deoxygenated blood)-->then the blood enters the lungs where it gets some oxygen-->then the oxygenated blood leaves the lungs via the pulmonary veins (these are the only veins in the body that carry oxygenated blood)-->then the blood enters the left side of the heart-->it first goes through the left atrium and then to the left ventricle (the BIG bad pump). The aorta is the beginning of the arterial system. The oxygenated blood is delivered throughout the body. Once all the of oxygen has been used up out of the arterial blood then the arterial system ties back into the venous system and the blood is carried back to the heart and the entire process begins again. |
|
|
Thinking of Blood flow What happens with Right Sided Heart Failure?
|
In right sided heart failure the blood is not moving forward into the lungs… IF it does not move
forward, then it will go backwards into the venous system. |
|
|
Thinking of Blood flow What happens with Left Sided Heart Failure?
|
In left sided heart failure the blood is not moving forward into the aorta and out to my body… IF it
does not move forward, then it will go backwards into the lungs. |
|
|
What is the formula for assessing Cardiac Output?
|
CO=HR X SV (preload, afterload, and contractility)
Stroke Volume (SV) is the amount of blood pumped from the ventricle of the heart in one beat. Cardiac Output: Think LEFT Ventricle~How much blood your left ventricle is pumping out to the body |
|
|
Looking further into Cardiac Output (CO)...
1. If your heart is weak what will happen to cardiac output? 2. If your cardiac output is decreased will you perfuse properly? 3. Will you perfuse your brain very well? 4. Heart 5. Lungs 6. Skin 7. Kidneys 8. Peripheral Pulses 9. What will happen to blood pressure? Initially - __________________ 10. Short term - ___________________ |
1. Decrease
2. No 3. No (Decreased LOC) 4. No (pt c/o chest pain) 5. No (Wet lung sounds) 6. No (cold & clammy) 7. No (decreased urine output) 8. Decreased or Absent 9. Decrease (b/c less volume,less pressure) 10. SHould eventually come back up |
|
|
Arrythmias are no big deal until they effect what?
|
Your Cardiac Output
So if a pt goes into V-Tach, V-Fib, or Asystole there's not a problem until it effects the cardiac output! |
|
|
Chronic Stable Angina:
*What is happening to this pt? *What brings this pain on? *What relieves the pain? |
~-Decreased blood flow to myocardium (heart muscle)→ ischemia(decreased blood flow and oxygen to heart)→ temporary pain/pressure in chest
-Usually caused by CAD |
|
|
Chronic Stable Angina:
*What brings this pain on? *What relieves the pain? |
*low oxygen due to exertion
*rest and/or Nitroglycerin (sublingual) |
|
|
Chronic Stable Angina:
*Treatment (Medications) ~List 4 Types of Meds |
*Nitroglycerin
*Beta Blockers *Calcium Channel Blockers *Aspirin |
|
|
Chronic Stable Angina:
*Treatment (Medications) ~Specifics for Nitroglycerin |
-Take 1 every 5 min X 3 doses
-Teach client to remove the cotton from the container as it absorbs the drug -Okay to swallow? No -Keep in dark, glass bottle; dry, cool -May or may not burn or fizz -The client will get a headache. -Renew how often? 6 months -After Nitroglycerin (Nitrostat®), what do you expect the BP to do? decrease |
|
|
Chronic Stable Angina:
*Treatment (Meds): ~Specifics for Beta Blockers |
-Examples: Propranolol (Inderal®), Metoprolol (Lopressor®/Toprol XL®),
Atenolol (Tenormin®), Carvedilol (Coreg®) -What do beta blockers do to BP, P, and myocardial contractility? Decrease -What does this do to the workload of the heart? Decrease |
|
|
Chronic Stable Angina:
*Treatment (Meds): ~~Specifics for Calcium Channel Blockers |
-Examples: Nifedipine (Procardia XL®), Verapamil (Calan®),
Amlodipine (Norvasc®), Diltiazem (Cardizem®) -What do these do to the BP? decrease -They also dilate coronary arteries |
|
|
Chronic Stable Angina:
*Treatment (Meds): ~Specifics for ASA |
dose is determined by the physician (81 mg-325 mg)
|
|
|
Chronic Stable Angina:
*Treatment (Pt Education/Teaching) |
-avoid isometric exercise (exercises that make your muscles squeeze/tense up)
-avoid overeating -rest frequently -avoid excess caffeine or any drugs that increase HR -wait 2 hours after eating to exercise -dress warmly in cold weather (any temperature extreme can precipitate an attack) -take nitroglycerin prophylactically -smoking cessation -lose weight ** #1-DO EVERYTHING YOU CAN TO DECREASE WORKLOAD |
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
*What is happening to this patient? |
-Decreased blood flow to myocardium →ischemia and necrosis occur
-Does the client have to be doing anything to bring this pain on? No -Will rest or Nitroglycerin (Nitrostat®) relieve this pain? No |
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
~Does the client have to be doing anything to bring this pain on? ~Will rest or Nitroglycerin (Nitrostat®) relieve this pain? |
~No
~No |
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
~S/S (6) |
-pain
-ECG changes -cold/clammy -BP drops ↓ cardiac output -↑ WBC’s and ↑ temp due to inflammation ~Vomiting |
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
*Dx (What are the cardiac enzymes that are drawn?) |
-CPK (CK-MM, CK-BB, CK-MB)-isoenzymes
-CK-MB, elevate at 3-8 hours after the onset of chest pain. Peak in 12-24 hours and return to baseline within 3 days -LDH (l, 2, 3, etc.) BB= Brain MM= Skeleton Muscle MB= Heart CPK= creatine phosphokinase CK= creatine kinase CPK is also called CK |
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
Which isoenzyme is most indicative of an MI? |
CK-MB
|
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
What do you know about Troponin? |
Troponin (cardiac biomarker/cardiac marker)
**IT'S ONLY ELEVATED WHEN SOMETHING CARDIAC IS WRONG** Normal Value= 0.0-0.10 |
|
|
Acute Coronary Syndromes: MI, Unstable Angina: 'Unpredictable"
-Which enzymes/markers are most helpful when the client delays seeking care? _____________ and ______________________ |
LDH (enzyme) and Troponin (marker)
~-Serial enzymes and markers will be drawn on the client -the frequency depends on the doctor’s order |
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
What is STEMI and NSTEMI's? |
~STEMI-ST-Segment Elevation Myocardial Infarction-this indicates that the client is having a heart attack
and the goal is to get them to the cath lab for PCI in less than 90 minutes. ***WORRY ABOUT THIS CLIENT*** ~NSTEMI’s-Non-Elevation ST Segment Myocardial Infarction-these clients are usually less worrisome. |
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
*Treatment (Medications) As soon as a pt with chest pain comes to the ER what 4 things would they receive? |
Morphine
Oxygen Nitroglycerin ASA |
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
*Treatment: What untreated arrhythmias will put the client at risk for sudden death? |
*V-Fib (MAIN ONE)
*Pulselessness V-Tach *Asystole |
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
*Treatment: What anti-arrhythmic drugs are commonly used in the treatment of V-fib? |
Lidocaine or Amiodarone
|
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
*Treatment: What is a sign of toxicity with Xylocaine (Lidocaine®)? |
Any Neuro Changes
|
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
*Treatment:What is an important side effect of Amiodarone (Cordarone®)? |
Hypotension (MAJOR ONE), other arrythmias
What are you worried about with other arrhythmias? Decreased Cardiac Output |
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
*Treatment: Positioning-How would you position this pt? |
Head up position. Why? Not flat because it stresses the heart
Decreases workload on heart and increases cardiac output. |
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
*Treatment: Medical Interventions- PCI (Percutaneous Coronary Intervention) |
-Includes all interventions such as PTCA (angioplasty) and stents
-Major complication of the angioplasty: MI and Bleeding -Don’t forget the client may bleed from heart cath site -If any problems occur → go to surgery -Chest pain after procedure: call the doctor at once → re-occluding! ~angioplasty: for single and double vessel disease |
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
*Treatment:Coronary Artery Bypass Graft (CABG) |
-with multiple vessel disease
-left main occlusion which supplies the entire left ventricle |
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
*Treatment: Cardiac Rehibilitation |
-Smoking cessation
-Stepped-care plan (increase activity gradually) -Diet changes - decrease fat, decrease salt, decrease cholesterol -No isometrics exercises - they increase workload of heart -No valsalva -No straining; no suppository; Docusate (Colace®) -When can sex be resumed? When they can walk around the block or up a flight of stairs with no discomfort -What is the safest time of day for sex? Morning-want pt well rested -Best exercise for MI client? Walking -Teach S/S of heart failure: -Weight-Increase -Ankle Edema -Shortness of Breath -Confusion |
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
*Additional Interventions: Fibrinolytics |
-Goal: Dissolve the clot that is blocking blood flow to the heart muscle→ decreases the
size of the infarction 1) Medications: -Streptokinase (Streptase®) -Alteplase (t-PA®) -Tenecteplase (TNKase®) (one time push) -Reteplase (Retavase®) -How soon after the onset of pain should these drugs be administered? Within 6-8hrs-The sooner the better. -Stroke (3hrs) ~Alteplase (t-PA®) is the only approved fibrinolytic for stroke clients. Major complication: -Have to get a good history. Want a good bleeding history. -Absolute Contraindications: -Intracranial neoplasm, intracranial bleed, suspected aortic dissection, internal bleeding -During and after administration: -Take bleeding precautions, watch rhythm (reperfusion arrhythmias) draw blood when starting IV's, decrease punctures *on NCLEX don't draw an ABG b/c arteries really have lots of pressure 3) Follow-Up Therapy: -Antiplatelets are another important component of fibrinolytic therapy. -Acetylsalicylic Acid (Aspirin®) -Clopidogrel (Plavix®) -Abciximab (ReoPro IV®) -Eclientifibatide (Integrilin®) (continuous infusion to inhibit platelet aggregation) Standard of care in the REAL world: Your client will not get a fibrinolytics if you can get them to a cath lab within 90 minutes of arrival to your facility. Bleeding Precautions Watch for bleeding gums Watch for hematuria Watch for black stools Use an electric razor Use a soft toothbrush No IM’s ~to start fibrinolytics you want to do it at the anticubital site b/c it needs to be in a place where you can apply pressure incase it bleeds |
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
*Additional Interventions:Cardiac Catherterization |
1) Pre-procedure:
-Ask if they are allergic to Iodine/Shellfish/Dye -iodine based dye is used during procedure -Also we want to check their Kidney perfusion~because the client will excrete the dye through their kidneys. -Hot shot-when they inject the dye the pt will feel warm and flushed *tell pt before procedure* -Palpitations normal 2) Post-procedure: -Watch puncture site -Assess extremity distal to puncture site (5- Ps) -Pulselessness -Pallor -Pain -Paresthesia -Paralysis -Bed rest, flat, leg straight X 6-8 hours; can ambulate after this -Report pain ASAP -Major Complication: Bleeding |
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
*Additional Interventions: Post Cardiac Catherterization Patient Care |
After the cardiac catheterization procedure:
The client will be instructed to lie flat, with their leg straight for at least for 6-8 hours. (Depending on the medication the client has received and when the sheath was pulled… and of course… the doctor’s orders. The time may be more or less… but we are still WORRIED about the client hemorrhaging!) The client cannot elevate the HOB greater than 10-15 degrees. Be sure to educate the client and family about this. Vital signs and heart function will be closely monitored. Your hospital will have a policy for you to follow on how often the vital signs should be taken. The pulse in the affected leg or extremity will be monitored closely. Be sure that a baseline circulation check has been performed. Be sure you have marked the pulses BEFORE the client leaves for the heart cath. After the sheath has been pulled, a pressure dressing will be placed over the area. Be sure to monitor the site for any bleeding or hematoma formations. You should drink plenty of fluids to avoid dehydration |
|
|
Acute Coronary Syndromes: MI, Unstable Angina: "Unpredictable"
*Additional Interventions: Pacemakers |
1) Uses:
-Used to increase the heart rate with symptomatic bradycardia -They electrically stimulate the heart muscle...hopefully a resultant contraction will occur. -Depolarization - when electricity is going thru the muscle -Repolarization - resting, ventricles are filling up with blood 2) Types: l. Temporary 2. Permanent 3. Transcutaneous -Pacemaker Responses: -Demand: kicks in only when the client needs it to -Fixed rate: fires at a fixed rate constantly -It’s ok for the rate to increase but never decrease Always worry if the rate drops below the set rate. 3) Tx: a) Post-procedure Care: -Monitor the incision -Most common complication in early hours? Electrode Displacement -Immobilize arm: to keep the client from raising their arm too high -PROM to prevent frozen shoulder b) S/S of malfunction: -Any sign of decreased CO or decreased Rate c) Client education/teaching: -Check pulse/Hear Rate daily -ID card -Avoid microwaves/ MRIs -Avoid contact sports |
