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What is the number one cause of coronary artery disease?
Imbalance between oxygen supply and demand
Which type of angina is increased with exertion and relieved with rest and NTG?
What type of angina is poorly relieved with NTG and occurs at rest?
What type of MI is most deadly?
If you have an ST elevation in inferior lead, you would assume what part of the heart is infected?
What do positive chronotropic drugs do?
Increase heart rate (atropine, epi, dopamine)
What do negative chronotropic drugs do?
Decrease HR (beta blockers)
What reflects the filling pressure of the right ventricle (preload)?
Central venous pressure monitoring
What reflects the Left ventricular preload?
Pulmonary capillary wedge pressure (PCWP)
What is normal CVP?
Client has a CVP reading of 8, what is the appropriate nursing diagnosis?
Fluid volume overload (Hypervolemia)
Client has a CVP reading of 1, what is the appropriate nursing diagnosis?
Fluid volume defecit (hypovolemia)
What is the primary cause of decreased preload with a CVP line?
What is the normal range for PCWP?
If the patient has a high PCWP (18), what does this indicate?
Fluid is built up in the Right side of the heart
What is the main interventions you need to remember with the Persantine (adenosine) stress test?
- Withold all medications such as theophylline. It's ok to give morning cardiac meds, but would still hold theophylline.
- NPO for 4 hours
- No smoking, no alcohol
Which test would you expect to be done on a patient who can not breathe without taking theophylline?
Dobutamine stress test
What are the nursing interventions for a thallium scan?
- Continuous telemetry
- Large bore IV site (big gauge- 18g)
- Patient needs to lie very still for thallium scan
What is the priority nursing intervention post- procedure for cardiac catherization?
- Check neurovascular status of the leg that was cathed
- Other interventions include: 4-6 hrs bed rest, keep legs straight for multiple hours
What is the invasive procedure where there is rapid inflations and deflations of cath to break up the plaque?
Percutaneous transluminal coronary angioplasty (PCTA)
What invasive procedure is when: woven stainless mesh that provides support to a vessel at risk of acute closure?
- Coronary artery stent
- - Stent may be coded in medication so that platelet will not stick to it
Catheter shaves and removes plaque from artery
Graft around blocked arteries to restore adequate blood flow to heart muscle: take vessels from another part of the body, and graft them into where coronary arteries are blocked in order to feed the heart muscle
coronary artery revascularization bypass (CABG)
What level is therapeutic for heparin?
aPTT will be 1.5 to 2 times the normal
If your _______ is below 60, you will go into renal failure within hours.
MAP: mean arterial pressure
What are the signs and symptoms of a retroperitoneal bleed (retroperitoneal hematoma)?
- Flank pain
- back pain
- abd pain
How often should you measure blood pressure post-op to a CABG?
Arterial b/p every 15 minutes
How often should you measure urine output post-op CABG?
- 1/2- 1 hour.
- You should have 1/2-1 cc/kg/min. Minimum of 30 cc an hour.
What type of nutritional teaching should the patient be given post-op invasive coronary artery procedures?
low sodium, low cholesterol, low cards
What symptoms does the patient post- coronary artery procedure need to report?
- chest pain with minimal exertion
When can the patient have sex post- coronary artery procedure?
3rd or 4th week post - op
What is teh main goal of cardiac rehab?
Extending and improving the quality of life
What are the phases of cardiac rehab?
- Phase I- in hospital
- Phase II- after discharge
- Phase III- usually self directed
Systole is the sound of what?
Mitral and tricuspid valves closing
Diastole is the sound of what?
aortic and pulmonic valves closing
______ is when a portion of one or both valve leaflets stretch into the atrium during systole
mitral valve prolapse
_____ is when blood flows back from the left ventricle into the left atrium during systole
____ is when valves do not close- not enough blood gets thru
What are the causes of mitral valve prolapse?
- direct damage (IV drug use)
- rheumatic fever
What grade murmur is associated with cardiac disease
What is mitral stenosis most often caused by?
Pulsations in the head and neck, and a widened pulse pressures indicates what?
What procedure separates leaflets?
What is the target INR for coumadin?
What needs to be taught in infectious endocarditis prevention?
- Antibiotics prior to dental procedures
- avoid toothpicks
- iv drug use
What happens in cardiomyopathy?
- Structural and functional abnormalities of the heart muscles itself (myocardium)
- - you get low stroke volume
- -patient has tighter vessels
- -starts retaining salt
_______: ventricles are dilated without hypertophy of the muscle wall itself.
_______ heart muscle increases in size and mass
_______: rigid ventricular walls, idiopathic
What do you need to be careful of with hypertrophic cardiomyopathy?
Dehydration! Avoid dehydration
______ endocarditis: develops rapidly. May result in death
syndrome caused by bacterial or viral infection that causes inflammation of the pericardial sac
What are the 3 signs associated with acute cardiac tamponade?
Becks triad- hypotension, JVD, muffled heart tones
inflammation fo the heart muscle, usually viral cause or immune related
When medicating the patient with myocarditis, what do you need to be careful about?
- Sensitive to dig b/c of inflammation of cells
- Do not give beta blockers- may block cells that are giving correct passageway
What are the side effects of Ace inhibitors (PRILS)?
- Dizziness/ hypotension
- check bp, renal function, and K+
What is the digoxin safe level?