Test 1

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Author:
amber1026
ID:
32283
Filename:
Test 1
Updated:
2010-09-01 17:44:44
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Cardiac
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Description:
Acute MI
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  1. Whats going on with Angina
    - not enough
    - usually associated with
    - precipitating factors
    • - myocardal supply
    • - atherosclerosis,arteriosclerosis, vasospasm, myocardialhypertrophy, severe anemia, respiratory disease,tachycardia, hyperthyroidism, increased forceof contraction as seen with HTN
    • - Running, going upstairs, getting angry, respiratoryinfection with fever, exposure to cold weather,eating large meals
  2. what do we see (with angina)
    - recurrent, intermittent
    - usually triggered by
    - pain described as
    - may have
    - vary in...and lasts
    • - brief episodes of substernal chest pain
    • - physical or emotional stress
    • - “tightness or pressure in the chest, may radiate to neck or left arm.
    • - pallor, diaphoresis, nausea
    • - severity and lasts a few seconds to minutes
  3. Treatment for Angina
    - have pt
    - sit in
    - admin
    - check
    - if no hx, call 911 after
    - if hx give...if no relief...
    • - patient rest, stop activity
    • - upright position
    • - NTG (sublingual); oxygen if needed pulse oximetry <95%
    • - pulse/respirations
    • - should call 911 after 2minutes if pain not relieved on its own
    • - NTG X 3, 5 minutes apart if needed, if norelief treat as AMI, Call 911
  4. NTG
    - for angina use waht form
    - pill under toungue should
    • - fast acting
    • - fizz
  5. Acute Coronary Syndrome
    - S/S of
    - unstable
    - NSTEMI
    - STEMI
    - sudden reduction of
    • - myocardial ischemia:
    • - angina
    • - non ST segment elevation MI
    • - ST segment elevation MI
    • - blood flow to the heart
  6. Unstable Angina
    - causes
    - S&S
    - Dx
    - Tx
    • - Partial thrombus or intermittent occlusion of coronary artery
    • - Pain with or without radiation to arm, neck or epigastric region •SOB, Diaphoresis,lightheadedness,tachycardia, decreased arterial oxygen saturation and rhythm abnormalities
    • - ST depression or T wave inversion on ECG •Cardiac Biomarkers not elevated
    • - Oxygen to maintained >90%•NTG or Morphine to control pain•Beta blockers, ace Inhibitors, Statins on admit and DC clopiodogrel (plavix) unfractionated heparin or low molecular weight heparin, and glycopaclin Ib and IIb inhibitor
  7. NSTEMI
    - causes
    - S&S
    - Dx
    - Tx
    • - Thrombus partially or intermittently occludes coronary artery
    • - Same as unstable angina Pain is longer in duration and more severe than unstable angina
    • - Same Changes on ECG* Cardiac biomarkers are elevated
    • - Same as unstable angina* Cardiac Catherization and possible PCI with STENTS for patient with ongoing pain, unstable,increased risk of worsening of clinical outcomes
  8. STEMI
    - causes
    - S&S
    - Dx
    - Tx
    • - Thrombus fully occludes coronary artery
    • - Same as NSTEMI but also have irreversible tissue damage (infarction)occurs if perfusion not restored
    • - ST elevation or new LBBB on ECG•* Cardiac biomarkers are elevated
    • - Same as NSTEMI Percutaneous Coronary Intervention, within 90minutes MD evaluation Fibrolytic therapy within 30 minutes of arrival
  9. Who is at risk for AMI, unstable angina
    - non modifiable
    - modifiable
    • - (age, sex, family history, ethnicity or race): Men > women, men over 45; women over 55; Anyone with first degree male or female relative who developed heart disease before age of 55 or 65
    • - Increased serum cholesterol, LDL’s, Triglycerides; Decreased level of HDL; DM II, Smokers, Obesity, HTN, Stress, Sexual activity, Sedentary life style, Hyperthyroidism, Methamphetamine or cocaine use
  10. S&S of ACS
    - degree to which coronary artery is occluded typicallycorrelates
    - recognizable classicsymptom of ACS
    - frequency and intensity can increase if not resolved with
    - may last longer than....and may not
    - along with CP may have...
    • - presenting symptoms and with change incardiac markers, ECG changes
    • - Angina or Chest Pain
    • - rest, NTG, orboth
    • - 15 min; radiate
    • - SOB, Diaphoresis, Nausea, Lightheadedness, change in V/S, Tachycardia, tachypnea,HTN, Hypotension, decreased sao2, Cardiac rhythm abnormalities
  11. Atypical ACS symptoms
    - women
    - frequently present with
    - tend to experience
    - report as
    • - SOB, fatigue, lethargy,indigestion, anxiety prior to AMI
    • - palpitations, pain in the back rather than substernal or in the left side
    • - numb, tingling, burning, stabbing pain
  12. Atypical ACS symptoms
    - silent ischemia
    - occurs w/out
    - 50% dx with AMI did not have or exhibit classic sx of...
    • - s/s
    • - Chest Pain, especially diabetics,women, older adults with history of heart failure
  13. Dx with ACS
    - h/p
    - cardiac troponin T & I most specific for cardiac muscle damage; may predict
    - if cant do troponin at facility then do....which is...
    - myoglobin, heme protein not cardiac specific. But 1st to increase after; increases withn
    - ECG
    - Unstable Angina and NSTEMI will have ST
    - ST elevation in 2 contiguous leads is dx
    - Abnormal Q wave appears in presence
    - once have Q wave
    • - present symptoms, biomarker levels and ECG
    • - degree of thrombus formation and micro vascular embolism
    • - get CK-MB; less accurate, with more false +
    • - damage to myocardium; 3 hours and the Troponin willnot be increased yet
    • - 12 lead within 10 minutes arrival to ED, can tell ischemia, injury or infarction locate affected area, assess related conduction abnormalities
    • - segment depression, invertedT wave, ST depression resolves when ischemia or pain resolves but mayhave a persistent T wave inversion
    • - of STEMI; may also have T waveinversion, normally subsides within hrs of the AMI
    • - MI due to alterations inelectrical conductivity of Myocardial cells,
    • - will alwayshave a Q wave so not signal AMI but can indicate an old MI
  14. Initial meds used with Angina
    - MONA (not in that order!)
    Asprin, oxygen, ngt, morphine sulfate
  15. with angina give what first
    asprin
  16. Asprin for CP (agina)
    - dose
    - when
    - contraindicated in
    - s/s for asprin toxicity
    - works by
    • - 165-325 mg orally, chew, crush, can place under the tongue then 81-325 mg daily
    • - ASAP after onset of symptoms; unless contraindicated
    • - GI bleed active ulcer disease bleeding disorder allergy to aspiriGI bleed, disease, disorder, aspirin
    • - tennitus, ringing in ears
    • - inhibiting platelet aggregation and vasoconstriction by preventing production of thromboxane
  17. oxygen admin in angina
    - dose
    - be alert for
    - works to...
    • - 2-4 L/min via nasal cannule keep SaO2 > 90%
    • - S/S of hypoxia
    • - increase the amount of oxygen that goes to myocardium thus decreases pain associated with myocardial ischemia
  18. Asprin admin
    - inhibits
    - contraindications
    - SE
    • - platelet aggregation
    • - Don’t give to children (Reyes), allergy,bleeding disorders, GI ulcers
    • - used for platelet aggregations; bleeding, epigastricdistress
  19. Nursing implications for asprin admin
    - potential for toxicity higher in
    - give with
    - do not take when
    • - older adults and children
    • - mild or full glass of water to decrease GI irritation
    • - one week prior to invasive procedure, notify MD
  20. Morphine Sulfate
    - action
    - use for
    - contraindication
    - SE
    - toxicity
    • - dilates coronary artery; interacts at specific receptor binding sites
    • - pain; decreases anxiety, therefore decreases myocardial oxygendemands with pain from ACS
    • - hypersensitivity, head injury, hepatic renal dysfunction
    • - most serious respiratory depression, most common confusion,orthostatic hypotension, constipation, tolerance with long term use
    • - coma, respiratory depression, pinpoint pupils
  21. Nursing Implications with Morphine admin
    - assess
    - document using
    - reversal agent
    • - pain, v/s prior to dose
    • - strict inventory assessment of narcotics
    • - naloxone (narcan)
  22. with acs give morphine until
    pain is gone (2-4mg IVP every 5 to 15 min)
  23. Clopidogrel (plavix)
    - indicated for
    - non ST segment elevation ACS
    - give
    - ST segment MI
    - give
    - SE
    - teaching
    • - single 300 mg oral loading dose then 75 mg/Q day and start ASA 75-325 mgdaily
    • - 75 mg daily with ASA 75-325 mg/day with or without thrombolytic may be startedwith or without the loading dose
    • - Most common bleeding; Most severe TTP(Occurs within or < 2 weeks)
    • - take as ordered, monitor platelet count, hold 3-7 days before invasive procedure
  24. when pushing fluids after dye is given make sure they are...
    peeing the fluid out as not to OVERLOAD them
  25. reperfusion therapy
    - recommended for
    - includes
    - goal
    • - pt with STEMI
    • - PCI, fibrinolytic drug therapy
    • - restore blood flow to myocardium (PTCA, STENT, arthrectomy)
  26. reperfusion therapy
    - PCI indicated if
    - PCI in how long
    - post care
    • - onset symptoms occurred within 3 hours,fibrolytic therapy contraindicated for some reason, patient ishigh risk HF, STEMI diagnosis not absolute
    • - 90 minutes from medical evaluation
    • - frequent monitoring, v/s, rhythm, pulse, pain,insertions site, i/o
  27. Glycoprotein IIb/IIIa inhibitors
    - examples
    - indicated for
    - work by
    - dose (load, infusion)
    - reopro
    - integrilin
    - angioplasty
    - aggrastat
    • - Eptifibatide (Integrilin), Tirofiban (Aggrastat), Abciximab (ReoPro)
    • - AMI, Unstable Angina, Angioplasty
    • - inhibiting platelet aggregation
    • - load – 0.25 mg/kg IVP; Infustion 0.125 ug/kg/min up to 10 ug/min IV X 12 hours
    • - load 189 ug/kg; Infusion 2 ug/kg/min IV X 72 hours;
    • - Angioplasty-load 135 ug/kg IV prior to procedure; Infuse 0.5 ug/kg/min IV X 24 hours
    • -Load 0.4 ug/kg/min for 30 minutes; Infusion (AMI 48-108 hours; Angioplasty 12-24 hours)
  28. Fibrolytics
    - do what
    - examples
    - give within
    - initiate within
    - contraindication
    - complication
    • - administer clot bustingdrugs dissolve existing thrombus
    • - alteplase (activase); reteplase (retavase) tenecteplase (TNKace)
    • - 3 hours of symptoms although can give up to 12 hours but giving after 24 hoursCan be harmful.
    • - 30 minutes of medical evaluation
    • - bleeding disorder; recent ischemic stroke; CVA disease; uncontrolled HTN, brain tumor
    • - Bleeding, hemorrhage
  29. Alteplase (activase)
    - weight dependent
    - half life
    - dosing
    • - yes
    • - 4-8 min
    • - IV bolus, 90 min continuous infusino
  30. Reteplase (retavase)
    - weight dependent
    - half life
    - dosing
    • - no
    • - 13-16 min
    • - 2 rapid bolus of 10 units each 30 min apart
  31. Tenecteplase (TNKace)
    - weight dep
    - half life
    - dosing
    • - yes
    • - 20-24 min
    • - single IV bolus
  32. Nursing Assessment with Reperfusion therapy
    - monitor
    - ECG
    - have IV
    - SaO2
    -I/V
    • - s/s (asymptomatic, CP, Dyspnea); v/s q 15 min till stable then Q 4hrs
    • - serial; monitor bedside or telemetry
    • - access
    • - continuous, keep >90
    • - hourly or >30ml/hr

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