Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
LSC Cardiovasc
Nursing
| Question | Answer |
|---|---|
| The 4 E's of Angina | Exercise, Excitement/Emotion, Eating, Environment - removal of these usually relieves pain & discomfort |
| Chronic Stable Angina | Activity demand for O2 > O2 in heart, Activity moderate to prolonged, Discomfort/pain, symptoms unchangeing, stop activity, If Rx for NTG - Pain goes away |
| Acute Coronary Syndrome | UNSTABLE ANGINA - Increased anginal attacks, comes w/less degree activity, pain not relieved by rest or NTG, increased severity and frequency MI - ST Segment elevation traditional, non ST segment elevation (f), Unstable angina, positive Troponins |
| Variant (Prinzmetal) Unstable Angina | Chest pain or discomfort resulting from coronary artery spasm typically AFTER REST, Tx Calcium Channel Blockers |
| Pre Infarction Angina | Chest pain occurs days - weeks b4 MI, Increase frequency, duration and intensity, occurs shortly b4 MI, Symptoms mimic MI |
| Myocardial Infarction MI | Heart Attack, Abrupt O2 depletion to myocardium, Irreversible myocardial cell death - lack of coronary blood flow and therefore O2, CAUSES: vasospasm, thrombosis, cocaine, trauma, abrupt hypotension |
| Zones of Cell Death | Zone of Necrosis: Tissue Death, Zone of surrounding necrosis: Injury, Zone of surrounding injury: Ischemia |
| Left Anterior Descending (MI Location) | most of the LV muscle, *Leads to decreased pumping ability, *Highest Mortality |
| Left Circumflex (MI Location) | Back side of LV, may affect electrical system (SA & AV) |
| Right Coronary Artery (MI Location) | Right Ventricle, electrical system impact, *Dysrhythmias |
| MI Symptoms in women | Atypical: dyspnea, indigestion, pain between shoulders, radiating, choking sensation, 78% have symptoms for a month b4 MI |
| Cultural/Gender Impact | women: Do not recognize the signs of heart disease, protected by estrogen, heart disease increases after menopause, AA & Hispanic women, American Indians & Alaskan Natives, Leading cuase of death Euro Americans |
| Omega 3's | Decrease lipids, decrease sudden death events, fish 3x/wk or daily 1g fish oil supplement, flaxseed, flaxseed oil, walnuts and cnola oil |
| Nursing Intervention for CAD | EDUCATION on prevention! |
| Priority Actions for pt w/CAD Symptoms | Rapid Assessment of chest pain, *PAIN RELIEF* Morphine Sulfate (or nitro), O2 2-4L, VS need to stabalize q5-15min, when stabalized - continue assessing |
| Nursing Dx: Acute PAIN | Related to O2 need & demand to myocardial, outcome - relieve pain, ER interventions - eval pain, IV access, chew one ASA to prevent further occlusion, ECG, Monitor vitals q5 min |
| NTG Hospital | 1 tablet every 5 minutes x3 to relieve pain, VS: If BP falls >100, Lower HOB, IV NTG drip titrated until relief, If BP falls >90, stop NTG or add IV vasopressor (Dobutamide) to maintain BP on IV Nitro Drip *Do not give to pts taking viagara! |
| Morphine Sulfate IV | given if unresponsive to NTG, Decreases myocardial O2 demand, relieves anxiety, Decreases circulating catecholamines, given in 1-2mg IV boluses, Monitor RR & SE of MS, Resp Depression, N&V, *NALOXONE (NARCAN) antedote |
| Antedote for Morphine Sulfate IV | Naloxone (Narcan) |
| More Interventions for MI | O2 2-4L/min, Semi Fowlers Position (when BP is stable), Calm Quiet Environment), Deep Breaths to increase O2, Explain the tx and interventions to pt And family, Teach family about equipment and to remain calm |
| NTG @ Home | Take 1 tablet, wait 5 minutes, if pain is still present, CALL 911 and take 2nd tablet. if pain still present (5 min later) take 3rd tab. only up to 3x. Storage: Dark brown bottle, Light and heat sensative, refill q 3-5 months |
| ASA | disrupts blood clotting, effects on platlets within 1 hr. @ HOME: take 1 325mg tab or 4 81 mg(baby asprin) tabs and call 911 |
| Thrombolytic Therapy - Fibrinolytics | Tissue plasminogen activator (t-PA), Alteplase (Activase), Reteplase (Retavase), Tenectiplase (TNK) *monitor for bleeding |
| Thrombolyitcs - Nursing Interventions | Route is IV or intra coronary during angiogram, Give within 1st 4-6hrs to be effective, contraindications (hemorrhage, stroke, active bleeding), Monitor for signs of bleeding - Neuro stats |
| Gluycoo-protein inhibitors | Abciximab (ReoPro) IV, Prevents fibrin from attaching to platlets, Unstable angina, givin prior to PTCA, Thrombolytics doses are decreased. |
| Beta Blockers | Carvedilol (Coreg, Coreg CR) Metoprolol (Lopressor) Monitor HR & BP, Decrease size of infarction, slow HR and decrease force of contraction |
| ACE Inhibitors | Monitor 1st 48hrs for Decreased U/O, Low BP, and Cough end in -pril |
| Stool Softners | Drug also prescribed post MI |
| Calcium Channel Blockers | ARE NOT USED FOR POST MI, Used for Angina, Varient Angina, HTN, Stable Angina *Monitor Hypotension* Enolzaine (Ranexa) added if CCB Not effective |
| Plavix (Clopidrogel) | Can be combined w/ASA for MI and Stroke Take with food, bleeding and bruising may occur - ice and elevate. GI Upset |
| Reperfusion after PTCA | done 2-3hrs after onset of symptoms, ASA & IV Heparin is given to prevent reocclusion of artery, Heparin 3-5days, (PTT) or Lovenox, Coumadin, Plavix |
| After Lysis of Clot Monitor FOR: | Abrupt Cessation of pain/discomfort, Decreased HR, Dyspnea, Sudden onset of Ventricular *Dysrhythmias, and Resolution of ST Seg Depression |
| Nursing Intervention: Activity Intolerance | Outcomes: Walk at least 200ft 4x/day w/o chest pain or dyspnea |
| Cardiac Rehab | Phase I Hospital Phase, Phase II After D/C - Monitored Activity, Phase III Long Term Conditioning - Elective Monitor Phase I or II Monitor I and II HR BP RR level of fatigue pain do not advance if not tolerated |
| Nursing Intervention: Potential For Dysrhythmia's | Dysrhythmia's are leading cause of deathOutcome: to return to normal sinus rhythem with normal BP |
| Nursing Diagnosis: Potential for recurrent symptoms and extension of injury | Outcome: Minimal Angina w/ADL's and Exercise, Use meds as prescribed Use NTG as needed for pain or before exercise, |
| Nursing Diagnosis: Potential for Heart Failure | Leads to decreased cardiac output, pulm congestion, systemic edema - legs and ankles, sacral, jugular and liver distention |
| Home Care Management | Do not D/C to home alone, Teach Family CPR, Defib, call 911 at 1st signs of uncontrolled angina, healing will be 6-8 weeks, |
| Coronary Artery Bypass Surgery - OLDER ADULT | Mortality Rates are higher in pts > 60, Monitor Neuro and Mental status, Obsdrve for SE of cardiac drugs, Monitor for dysrhythmias, 4-6postop surgery fatigue, chest discomfort, no appetite, teach pt to notify where they are going |
| Activity for pt w/CAD | 400ft 3x/day, carry NTG with you at all times, check HR before, after and during exercise, STOP IF PULSE increases above 20bpm, dyspnea, angina, or dizziness, exercise outside when weather is good, gradually increase walking distance AVOID STRAINING! |
| Nitroglycerin (Nitrostat, Nitroquick) Nitrolingual Translingual Spray | Lie down HOB at level of comfort, Monitor BP, let Sublingual Tablet disolve do not swallow, check exp. date (3-5mo shelf life) Monitor for HA, Determine if pain is relieved |
| Isosorbide dinitrate (Isordil, Iso-Bid) | Long term, Sublingual, Instruct pt to lie down, Monitor BP and assess for dizziness |
| Isosorbide mononitrate(Imdur) | extended release, tolerance may develop, take at time when pain is at it's highest |
| Nitroglcerin patch (Minitran, Nitro-Dur, Nitrek) | Remove patch b4 Defibrillation, rotate application sites, apply to a clean, dry, hairless area, Remove old patch & apply new after 12-14hrs each day - NURSE: Wear gloves when applying |
Created by:
ginabeana
Popular Nursing sets