Heart

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Author:
foxyt14
ID:
289805
Filename:
Heart
Updated:
2014-11-21 17:29:27
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Heart
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Description:
#3 Complications and treatment of MI/ACS Cardiogenic shock, pulmonary edema and valvular heart disease #4Dx and treatment of cardiovascular disease including angioplasty, PTCA, Stent and CABG #6 ABG's
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  1. MONA order
    • aspirin
    • O2
    • Nitro
    • monitor
  2. What do you give if you have given nitro x3 and they still have chest pain? Why?
    IV morphine

    decreases pain, relaxes patient, decreases HR and BP and decreases oxygen need of heart
  3. Upon arrival to the ED, patient w/ACS or suspected MI will get this done in less than 10 min.
    • VS
    • O2 sats?
    • IV access
    • Brief hx
    • Blood draw for cardiac markets and electrolytes
    • chest x ray
  4. Immediate treatment for ACS/MI
    • if O2 sats <94%=4L/min
    • Nitro spray/sublingual
    • aspirin up to 325mg
    • IV morphine if nitro didnt work
  5. 2 reperfusion therapies and goal times
    • door to balloon (PCI) <90min
    • door to needle (fibrinolysis) <30min
  6. Normal or non diagnostic ST change...what gets done?
    • serial cardiac markers
    • repeat ECG
  7. Non ST elevated MI..what do I do?
    Possible PCI
  8. STEMI...what do I do?
    thrombolysis or PCI or CABG prep
  9. Why are BB good?
    decreasing the HR decreases the hearts O2 requirements
  10. What do Clopidogrel and Glycoproteins do?
    platelet inhibition/atherosclerosis
  11. Rules for Fibrinolytic therapy....name drugs
    • given w/in 6 hrs of chest pain
    • ECG shows STEMI/MI
    • 2 IV's....1 for this drug, the other for fluids

    Activase/Streptase
  12. Contraindications for fibrinolytic therapy
    • coagulopathy
    • liver failure
    • recent surgery
    • stroke in last 3 months
    • SBP>200
  13. Sign of reperfusion
    washout phenomenon or PVC
  14. Signs of hypoperfusion
    • decreased LOC
    • oliguria
    • lactic acidosis
  15. ACS vs. Angina
    ACS has pain with inspiration and expiration and it doesnt decrease with position change
  16. How do you know fibrinolytic therapy has worked?
    • no more chest pain
    • ST elevation is normal
    • See EXPECTED reperfusion PVC

    **monitor patient for bleeding
  17. Beck's triad
    • Hypotension
    • Muffled heart sounds
    • Narrowed pulse pressure

    Is this right?
  18. S/S of Pericarditis?
    • Sharp pain with inspiration
    • shallow breathing
    • leaning forward
  19. Interventions for pericarditis
    • HOB at 45
    • provide over the table for support
    • manage pain with ASA, Tylenol, NSAIDS
    • Steroids for inflammation

    **dont breath deep or lay flat
  20. What causes rheumatic fever and then valvular dysfunction and how is it dx?
    strep infection that wasnt taken care of

    seen with an echo or chest x ray....patient will be tachy
  21. Treatment for rheumatic fever/valvular dysfunction
    • antibiotics
    • bed rest
    • steroids
    • NSAIDS

    Valves replaced??
  22. How do you get pulmonary edema?
    HF has L ventricle failure causing alveoli to get filled with fluid= crackles

    Pulmonary edema occurs and will be seen with dyspnea, orthopnea, decreased O2 sats, bad ABG's, chest pain, cough and decreased CO
  23. End result of pulmonary edema?
    cardiogenic shock
  24. What is cardiogenic shock and what is the goal of treatment
    decreased CO....

    want to decrease myocardial requirements and maximize CO
  25. What meds decrease pre load
    • morphine
    • lasix
    • nitro
  26. What med decreases after load?
    nitro
  27. What medication will dilate the coronary arteries
    CCB
  28. What medication improves heart contractility
    dopamine
  29. Meds given based on SBP
    • <70=norepi
    • 70-100 w/ signs of shock=dopamine
    • 70-100 w/out signs of shock=dobutamine
    • >100=nitro
  30. What does an intra-aortic balloon pump do?
    improves myocardial perfusion and decreases afterload and facilitates LV emptying
  31. Calculate MAP
    1systolic + 2 diastolic / 3
  32. Calculate CO
    SV x HR
  33. What is used to dx a blockage in the heart
    angiogram
  34. Post op care after a CABG
    • Chest tube-how much, color
    • epicardial wires to help w/arrhythmias
    • radial artery line
    • foley

    • Monitor:
    • UO, blood glucose, dysrhythmias

    watch temp...hypothermia will make them shiver, then vasoconstrict=HTN

    watch for hypovolemia (blood loss)
  35. CK-MB
    • shows heart muscle damage
    • takes 3 hours to elevate
    • back to normal in 3 days
  36. Troponin
    • tells if person is having/had MI
    • takes 4 hours to elevate
    • back to normal in 14 days
  37. BNP and levels
    shows heart failure

    • <100= possible/no HF
    • 100-300= slight HF
    • 900=severe HF
  38. What will find clots on a person with A fib?
    echo
  39. Tech Prophosphate
    damaged heart tissue will show as hot spots
  40. Thallium
    damaged heart tissue will show as cold spots
  41. Electrophysiology Study....who gets it and how's it done
    V tach and V fib

    • d/c anti arrhythmics and be NPO
    • stim arrhythmia
    • defib to terminate arrhythmia
    • start patient on new regime
    • take back to lab and see if working by stimulating arrhythmia
  42. Percutaneous Coronary Interventions/Stent....

    what do I check prior to procedure?
    opens occluded artery

    do they have kidney disease?  post treatment they will have lots of fluids to flush the dye...watch BUN and creatinine
  43. Manage during PCI/Stent placement
    watch patients response by taking VS, watching EKG and ask if they are having chest pains
  44. Nursing management after PCI/Stent placement
    • check under dressing q15min for 2 hrs for blood
    • IV fluids to flush dye
    • check distal pulses
    • *HOB 20
    • *straight leg
  45. Pressure dressing applied at femoral site can cause...
    vagal response....brady down....give atropine
  46. pH normal
    7.35-7.45
  47. HCO3 normal
    22-26
  48. PaCO2 normal
    45-35

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