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N370-03: Cardiac I

Interventions, Medications & Treatment pt. 1

InterventionProblem/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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