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N370-03: Cardiac I
Interventions, Medications & Treatment pt. 1
| Intervention | Problem/Background |
|---|---|
| Endocarditis; prophylaxis abx; stroke | Because _____ can cause infections d/t dental visits, we have to _____; and since it also leads to systemic emboli, we have to watch out for ____ s/sx such as altered ALOC, agitation, slurred speech, facial drooping d/t lack of O2 in the brain from a clot |
| Pericardial friction rub; sitting up and leaning forward (may also alleviate pain by putting pt in this position | To dx pericarditis, always auscultate heart sounds and LISTEN FOR ______ (creaky/scratchy friction heard by placing steth's diaphragm against chest and auscultating the left sternal edge of the 4th intercostal space); this is heard best when pt is _____. |
| NSAIDS/analgesics & positioning (sit up and lean forward or side lying); activity; pericardial tamponade; pericardiocentesis; pericardial window | For pts with pericarditis, we have to manage pain with ______ & ______, _____ tolerance, monitor s/sx of _______, _______ if tamponade, or ________ d/t chronic fluid accumulation. |
| ABX; immunosuppressants; HF meds (ACE inhibitors, ARBS, inotropes, Ca channel blockers, beta blockers, diuretics; crackels | For pts with myocarditis, we administer _____ (for infection), ______ (for autoimmune etiology), _____ (if HEART FAILURE related); assess ______ (pulm congestion) |
| Cardiomyopathy; management | _________ has no cure & ______ only; manage HF and administer HF medications; bi-ventricular pacemaker may be required or implantable cardioverter defib for vent. dysrhythmias. |
| True | T or F: you have to know defining features of Left vs. Right HF. *Check Monique's SI notes for specific details/in depth explanations* |
| Dangle the legs | To help with dependent edema, you should _______ to reduce fluids in the lungs and pool them to the lower extremities. |
| Fluid volume overload; low C.O. | You should look for ______ s/sx when HF pt comes to the hospital b/c they're more common in the hospital compared to ______ s/sx. |
| 1+ (2mm), 2+ (4mm), 3+ (6mm), 4+ (8mm) | Grading edema *multiply score by 2 for the mm measurement* |
| Address the pumping issue (help dec workload) and fluid excess issues (diurese/pull back to ECV) | During HF in relation to HYPERvolemia d/t fluid back-up and low C.O., kidneys think body is hypovolemic b/c of poor perfusion d/t dec perfusion - RAAS -> inc Na & fluid retention -> inc BP -> inc workload of heart -> pt will destabilize; so we ______. |
| Diuretics (loop/K-wasting -ide, or K-sparing -one), ACE inhibitors (-pril), ARBs (-sartan), Beta blockers (-olol but B1 selective - BEAM Ne Ce), Digoxin (inotropic- know adverse sx), Entresto (ARBS + Neprilysin inhibitor b/c we don't want Nep to stop NPS) | What medications are the gold standard of therapy for heart failure? |
| Propanolol; Carvedilol | DO NOT give ______ or ______ to HF patients with asthma/COPD b/c it's NON-selective and it can cause bronchoconstriction -> call MD if COPD pt |
| Digoxin immune fab; renal function (Cr) | During digoxin toxicity, we have to administer the antidote, ______. And check _______ to see if there is inc risk for toxicity. |
| B E A A M Ne Ce = Betaxolol, Esmolol, Acebutolol, Atenolol, Metoprolol, Nebivolol, Celiprolol | What are the (B1) cardiac selectives beta blockers? |
| Diet*, Weight*, When to get help | What are 3 important concepts for pt education in HF? |
| Restrict sodium to 2000mg or less daily; avoid sodium sources such as table salt, inherent foods, and esp processed foods | What is the dietary restriction for HF? |
| Daily weights (use the same scale, garments, and at the same time everyday) | For HF pts, we have to perform ______ and NOT urine output b/c this is the best way to assess fluid gain/loss as it also accounts for fluids in the interstitial tissues. |
| 2-pound weight gain overnight or a 5-pound weight gain in a week | When should an HF pt report weight gain? |
| Frequent dry, hacking cough, SOB at rest, inc discomfort or swelling of lower extremities, sudden weight gain, anorexia, inc trouble sleeping (ASK how many pillows they sleep with at night) | When should an HF pt get help? |
| Anticoagulants; clicking; transplant medications (i.e. cyclosporine?) | Prosthetic valves will need lifelong ______ and ____ sounds are EXPECTED; while biological valves require _______ to avoid tissue rejection. |
| Temporary epicardial pacemaker | After shutting down the heart during surgery, a ________ might be needed until heart goes back to pumping normally. |
| SURE | *Know potential post-op procedures after heart surgery esp A. fib* |
| Pericardiocentesis; pericardial window | Intervention for ACUTE pericardial tamponade is _______; while for CHRONIC pericardial tamponade is _______. |
| Pulmonary edema | O2 administration, sit up with legs dependent for gravity to help pull fluids away from the lungs, nitroglycerin sublingual to dec afterload, furosemide IVP to rid of fluid (careful w/ hypokalemia), morphine (not advisable) are emergent actions for _____. |
Created by:
yortiz
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