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
BC3 cardiac 1/29/08
BC3 cardiac lecture 1/29/08
| Question | Answer |
|---|---|
| Intra aortic balloon pump) IAPB complications | compartment syndrom d/tdecreased blood flow to the tissues; foreign body, platelet problems,platelets destroyed;problems with bleeding;on balloon pumps are also placed on Heparin , disrupts the platelet activity; gas embolism can occur ; |
| Intra aortic balloon pump) IAPB complications | dissection of the aorta is another complication. |
| body systems that are monitored when you have a balloon pump are: | #1 mean arterial pressure (MAP) to indicate volume depletion and volume replacement – if the patient is getting low in volume it is evidenced by a low CVP or a low pressure that would be identified and volume would be repla |
| if the patient is getting low in volume it is evidenced by | low CVP or a low pressure that would be identified and volume would be replaced. |
| patient with a Swan, so we look at | pulmonary artery wedge pressure unless the patient is a post-op open heart and we do not wedge them – you would look at the PAD. |
| if pt. has (Intra aortic balloon pump) IAPB | You look at urinary output because that balloon can migrate and if it migrates towards the renal arteries then you are going to have decreased urinary output.ou also look at the left radial pulse because it can migrate proximal |
| (blank) | The head of the bed should be kept at less than 30 degrees and this is done to maintain perfusion to the extremity and to avoid hip flexion. |
| So the two reasons that we use a balloon pump | #1 to increase perfusion to the coronary artery #2 decreases the workload of the left ventricle |
| When would you have increased blood blow to the left ventricle or when would you use this for the left ventricle: | #1 If you have cardiogenic shock post MI; #2 If you have left ventricular failure |
| if a balloon pump is working correctly, your next | peak should be lower and in this case it is. What that means is that the left ventricle did not have to work as hard |
| why we put it inballoon pump | To decreased the workload of the left ventricle so it doesn’t have to use as much oxygen |
| Ventricular Assist Device or VAD | can be on the right, it can be on the left, or it can be bilateral. It is used in patient’s who are refractory to other treatments and it is used in the bridge for transplants. |
| if a patient is scheduled for a heart transplant and has severe left ventricular failure, they will use | L VAD. The goal of treatment is to provide adequate blood flow and to preserve end-organ function. |
| if you have decreased cardiac output, you have ? | decreased perfusion to the major target organs |
| criteria for an LVAD or a VAD is | #1 a systolic blood pressure of less than 80; Cardiac index of less than 2 and a Pulmonary artery wedge of more than 20 and this is all with the use of drugs |
| assistive device is this CPB – cardiopulmonary bypass | and it oxygenates the blood during surgery |
| So what are some of the complications of these devises IABP & LVAD | #1 Bleeding it disrupts the platelets;#2 right ventricular failure – the right ventricle fails if you correct the left ventricle and you increase cardiac output, that intern will increase venous return to the right heart. |
| right heart is used to?... | decrease venous return |
| #3 Thrombo-embolisms ; complications of these devises IABP & LVAD | because the plaque disruption and because of the anti-coagulation that is needed. Sometime you end up with a complication known as HITS – Heparin Induced Thrombocytopenia |
| complications of these devises IABP & LVAD; #4 Infection | because you broke the integrity of the skin |
| complications of these devises IABP & LVAD;#5 Dysrhythmias | because it is a foreign body – and can cause dysrhythmias tachy brady |
| complications of these devises IABP & LVAD #6 Nutrition, | many times these patient’s are intubated and they need enteral feedings or TPN. Is TPN good for a long period? Why not? feed the gut because bacteria will go else where to “feed” such as the blood – bacteria in the blood is sepsis |
| translocation bacteria. | most important to feed the gut and keep the bacteria where it belongs so it doesn’t migrate out – that’s’ called translocation bacteria. |
| complications of these devises IABP & LVAD #7 Last, these patient have a lot of psychological and social problems because of their limited activities | being encumbered with this large assistive device (LVAD). |
| management of dysrhythmias; how do we treat them? | cardioverison is an electrical shock to the heart depending on what dysrhythmias.for atrial flutter, so many joules |
| Dig level comes back at 3, what do you do? | he’s Dig Toxic….You don’t send him for cardioversion; A cardioverison is an electrical shock to the heart |
| a Dig level of 3; it is too high, so what do we do, | We give an antidote it binds the digitalis….Digibind! |
| IF they are on Dig, make sure you | have a Dig level before they go for cardioversion. |
| Theophylline Therapeutic level | Therapeutic is 10-20; |
| Theophylline level 30 | call the doctor; hold the dose; |
| jelly on those paddles or use those pads before you apply them to the chest , why? | otherwise they get burnt; So everyone has to physically be cleared – you can’t touch the rail or anything. And you discharge for a-flutter at 50; a fib 200; and SVT you start at 100; |
| Radiofrequency catheter ablation | find the area of ectopy and destroy it; find is usually an AV nodal re-entry tachycardia, so they can destroy it with ablation and take care of the problem |
| cardiac pacemakers | internal; another minor surgical procedure; see a little bump |
| external pacers have | a pacing wire or PA catheter that is placed and the generator is external. Why do you do that in SICU? you connect them and you can pace them externally |
| pacemaker term; Fire | there is a pacemaker spike |
| pacemaker term;Capture that | the pacemaker spike is followed by a wide QRS or if it is an atrial pacer it will be followed by a P wave |
| pacemaker term;Demand means | it fires when the heart rate is below a programmed rate |
| pacemaker term;Inhibit means | it is inhibited when the intrinsic rate rhythm is sensed |
| pacemaker term;Triggered means | it fires at pacer stimulus when it senses decreased intrinsic cardiac activity |
| 1st Letters of the pacemaker | first letter is the chamber that is paced – so it is the A, V or D; A meaning atrial; V meaning Ventricular; D meaning dual, both; |
| 2nd Letters of the pacemaker | second letter is sensed; it can be A, V, or D. |
| The third Letters of the pacemaker | the pacers response to the cardiac intrinsic activity; is it inhibited is it triggered or is it on dual. |
| VVI – Ventricular paced | ventricular sensed and inhibits;First one is paced, second is sensed and last one is inhibits or triggered. |
| complications that we find in a patient that has a pacemaker | . a pneumothorax – that can occur on insertion of a pacemaker |
| complications that we find in a patient that has a pacemaker | ventricular irritability – it’s a foreign body, so the ventricle may respond with ectopy;Perforation of the wall of the heart – it’s a metal wire into the chamber of the heart; Lead dislodgement – if that lead becomes dislodged; |
| complications that we find in a patient that has a pacemaker | Infections or phlebitis – again we have broken the integrity of the tissue; hiccups,spasms of the diaphragm;stimulating the phrenic nerve |
| ICDimplantable cardioverter defibrillators – | senses whenever a patient goes into v-tach or v-fib and it literally defibrillates the body; 1 ½ times the pacemaker |
| what’s the first letter in my pacemaker? | An A, because it is atrially sensed. at the p wave |
| pacemaker spike this straight up and down line and what do you see after it? A wide QRS, | ventricular |
| see two pacer spikes – | it is a dualpacer spike a P wave a pacer spike a QRS |
| why would a pacemaker fail to discharge | the battery died |
| fail to capture means | have a pacemaker spike and no QRS ,The battery died. |
| under sensing | – what can cause that? Lead dislodgement |
| Pericarditis | inflammation of the pericardium, can affect the diaphragm as well; can be primary, it can be secondary,due to an MI or due to renal failure, or it can be due to Dressler’s Syndrome |
| Dressler’s syndrome occurs | weeks or months after an MI and it is due to an autoimmune reaction secondary to the MI. |
| patient who had an MI in December and is now coming in because of severe chest pain, you need to think | Dressler’s Syndrome. |
| pericarditis, you have the classic | pericardial friction rub. It is at the left sternal and how would you know if it were a pleural effusion or a pleural friction rub versus a pericardial friction rub ; have them hold breath and listen; goes away pleural, doesnt go away, cardio |
| Constrictive pericarditis is usually due to | adhesions and results in decreased diastolic filling. So if you have decreased diastolic filling, what does that do to your cardiac output? Decreases your cardiac out put. |
| Constrictive pericarditis ; how to treat it? | NSAIDS – we simply use NSAIDS for pain control. Aspirin, Ibuprofen, Naproxene, Indocin, any of those NSAIDS;treatment with NSAIDs, the patient will resolved in about 2-6 weeks |
| patient who has pericarditis, the pain changes according to his position | chest pain on lying flat and deep breathing. It is relieved by sitting up and shallow breathing. pericarditis, it is going to get better when he gets up |
| see on the EKG classic diffuse ST elevation and number 3 – position affects the pain. So, how would know if his chest pain would be due to ischemia or pericarditis? TEST QUESTION | If it’s ischemia, it is going to hurt regardless of where he is sitting or how he is sitting or where he is laying. If it is pericarditis, it is going to get better when he gets up |
| labs? What do you need for a patient who has pericarditis: | CBC & Diff – you want to see if he is actively infected; need an EKG;enzymes – is he having an MI; look at rheumatoid and rheumatoid titers – is an autoimmune disease like what you see in Dressler’s; blood cultures – is the patient septic |
| myocarditis is ? | inflammation of the myocardium and the conduction system of the heart. evidenced by conduction changes;occurs in the absence of an MI. ; due to toxins;drug abusers. IV drug abusers |
| left sided heart failure d/t myocarditis | pulmonary problems ;rise in enzymes, so we need some troponins or CKMB. There are non-specific ST-T wave ; pleuritic chest pain;fatigue and dyspnea;diagnosis is made on death – with an endocardial biopsy. No cure for it. only heart transplant |
| myocarditis can be diagnosed on? | diagnosed on symptoms and we would do an echo, a TEE, all those tests, but there is no cure other than a transplant |
| Endocarditis is an ? | infection of the endocardial surfaces including the valves |
| causes of endocarditis | rheumatic heart disease,IV drug abuse, valve replacements;has an AVR, MVR needs to be aware that they can develop endocarditis. Mitral valve prolapse is another cause and organisms such as staph and strep Enterococci as well |
| symptoms/ treatment of endocarditis | symptoms occur within 2 weeks of an infection and it requires a prolonged course of antibiotics. Usually anywhere between 21-28 days of IV antibiotics |
| how do we know if a patient has endocarditis? | #1 look very closely at the history – where did they come from 2 weeks ago – you know I went to the dentist and he did a root canal and he put a crown on – what does that say to you? And I have mitral valve prolapse and I forgot to take my antibiotic? |
| So what tests do we need to look at? / what are we looking for when we find pt. with mitral valve prolapse didnt take antibiotic prior to dental work | CBC & Diff, blood cultures, TEE / looking for vegetation on the valves – anytime you read an echo/there is vegetation on valve; means, bacteria on the valve; patient has endocarditis ;need to prolong IV therapy |
| symptoms/ of endocarditis | fevers and night sweats; regurgitant mitral valve;Systolic.MRS. ASS; can also have osler’s nodes |
| osler’s nodes | erythemateous skin lesions of the fingers and the toes. |
| Mortality rate for endocarditis | 20-30%. |
| What kind of antibiotic would the patient use for endocarditis? | Vancomycin.; What if it is staph, strep (gram positive)Cephalosporins |
| Cardiomyopathy | three basic kinds ; all affect the heart muscle; dilated;Hypertrophic ; Restrictive |
| dilated cardiomyopathy | 60% of all cardiomyopathy;cause alcoholism, viral infection and familial.most of it is familial |
| What we find with dilated cardiomyopathy | increasing ventricular chamber size with insufficiency of the valves;ventricle gets bigger and bigger;Insufficiency is the same as regurge or from impaired systolic function |
| What we find with dilated cardiomyopathy | heart does not contract well enough to get a good cardiac output. This will lead to v tach and v-fib. |
| Hypertrophic cardiomyopathy | young people, playing football or basketball, they drop "just like that" find on autopsy is a left ventricular hypertrophy ;dystolic dysfunction where the heart is unable to relax enough to fill ;decrease cardiac output result MI or failure |
| Restrictive cardiomyopathies | diastolic dysfunction; little hypertrophy;restrictive filling ;reduced compliance ; |
| The basic thing that we find with the cardiomyopathies is that they all present with signs of | CHF |
| signs and symptoms dilated cardiomyopathy | fatigue, weakness, CHF, left ventricular failure, dysrhythmias and MVR – mitral valve regurge. We treat the symptoms –dyspnea, fatigue, CHF, tricuspid regurge, mitral valve regurge, heart block and emboli |
| How do you treat hypertension | control and exercise restrictions |
| Hypertrophic cardiomyopathy signs and symptoms | dyspnea, angina, fatigue, syncope, palpitations, A-fib, and CHF; can be treated with additional things such as beta blockers, pacemakers and surgery. |
| peripheral vascular disease | look at atherosclerosis.(the buildup of plaque in the intima of the vessels.) plaque can cause obstruction in the upper extremities and the lower extremities; Berger’s and Reynaud’s |
| Berger’s disease PVD | very young male smokers; |
| Reynaud’s disease PVD | very young female smokers. |
| major cause of Reynaud’s and Bergers | smoking |
| Classic symptoms in peripheral vascular disease ; Berger’s and Reynaud’s | intermittent claudication; severe leg pain on ambulating,severe leg pain at rest;patient has severe ischemia |
| what screening mechanism could you as a nurse do in your doctor’s office if you only have a blood pressure cuff to determine if the patient has severe ischemia, mild ischemia or moderate ischemia in the leg? | ABI….ankle brachial index |
| Another way to identify Berger’s and Reynaud’s | angiography and if there is an occlusion, some times we can do stenting, most likely we do not. We can put them on calcium channel blockers. |
| severe Reynauds disease | hands go through color changes on exposure to cold. white, blue and red.White for severe vaso constriction, blue for cyanosis and red for re-vascularization. very painful |
| venous disease | venous stasis ulcers, DVT’s. Stasis ulcers of course are seen with long term peripheral edema, Chronic lympadenopathy. |
| 3 things in Virchow’s triad: The three things that cause a DVT: | Hypercoagulability ; Injury ;Venous stasis |
| Hypercoagulability | Anyone who has cancer ; genetic hypercoaguability ;lupus anticoagulant positive;MTHFR positive; So hypercoagulability is a reason for DVT |
| . Injury that can cause A DVT | if they had a crushing injury to the leg |
| Venous stasis that can cause DVT | sitting, sitting, sitting…venous stasis – developed a clot. |
| Virchow’s triad | you need two of these to develop clots. So, hypercoagulability and stasis |
| difference between treatment of an arterial insufficiency such as a peripheral vascular disease and a venous insufficiency is ? | position of the leg; for arterial insufficiency, the legs need to be dependent. For venous insufficiency the leg should be elevated |
| how do you position the legs if the patient has a peripheral vascular disorder? | venous insufficiency the leg should be elevated;arterial insufficiency, the legs need to be dependent. |
| aortic aneurysm;classified by? | the shape |
| saccular aneurysm | it looks like a sac |
| fusiform aneurysm | this is a flase aneurysm and this is usually caused by an infection or something. |
| aneurysm above the diaphragm | thoracic. |
| aneurysm below the diaphragm | is abdominal. |
| hear a bruit with a male who is hypertensive and is complaining of back pain | want to do an ultrasound/ good chance he has an aneurysm |
| treat the aneurysm | medicallywith Antihypertensives until they reach about 5 cm/manage that blood pressure/ 5 cm or greater they have surgical repair. |
| problems with aortic aneurysm | . Aortic dissection ;secondary to aortic rupture;separation of the medial layer of the vessels by blood; extends the whole way down; ripping or tearing chest pain; history of hypertension;diastolic murmur and on chest x-ray you find a wide mediastinum |
| with aortic aneurysm we need to do what tests | do a TEE and we need to do a CT with contrast. ?? surgical intervention if the patient survives. Mortality rate is very, very high. Timing is most important. |
| problem with aortic aneurysm | blood leak up there at the intimal tear and then it creates a false channel and then extends further. perfusion to the major organs? NO Ruptures very quickly, so mortality if very high. |
| Hypertensive crisis | have an acute blood pressure greater than 240/140. causes end organ damage; affects mostly the elderly and the black population; ; |
| hypertensive has been identified as a pressure of | 120-139. Diastolic is 80-89 |
| s/s Hypertensive Crisis | decreased urinary output, so they have decreased blood flow to the kidneys. They can develop retinal hemorrhages… |
| how do we treat Hypertensive Crisis | decrease the blood pressure over a period of 1-2 hours. with NITRO. Labetolol will also decrease the blood pressure and Esmolol is another beta blocker that can decrease the blood pressure very quickly. |
| MI. | number one killer in America of men and women |
| why do people have MI’s | most common atherosclerotic plaque; injury to the endothelium, by increased levels of cholesterol and triglycerides.; have a history, #2 of hypertension; lastly have history smoking. smoking is the biggest risk factor for sudden death in a pt.who's had MI |
| what you find with an MI | injury to the vessel and accumulation of cholesterol, calcium fibrin. This all causes an inflammatory response. |
| inflammatory response in MI | A fibrous plaque forms and ? calcification ensues as a result you have decreased blood flow and thrombosis. Symptoms usually present when the patient is about 75 % occluded. |
| Collateralization | the ability of the body to form blood vessels around the occlusion , with an MI;ischemic for a very long period of time; 80% occluded; body will create blood vessels around that occlusion to profuse area distal to it |
| screen people who have a high inflammatory response with what? | C-Reactive Protein. Anything greater than 3 identifies them at risk for an MI. |
| Risk factors for an MI | Uncontrollable are age; hereditary; race; |
| risk factors after a woman has gone through menopause for an MI | she looses the cardio-protection of estrogen risk increases = to men |
| risk factors for MI | pear shape women |
| Modifiable risk factors for MI | smoking; high cholesterol ; |
| how do you treat hypertension? | Diet, exercise, stress reduction. After that we go to what? MEDS ? Beta Blockers |
| Beta Blockers…how do they work for high blood pressure? | What do beta 1 do; regulatworks on the kidneys to decrease the secretion of renin.e heart rate |
| how does a beta blocker treat hypertension?? | decrease the secretion of renin. If you decrease the secretion of renin in the kidneys you don’t have a release of angiotensin I which is converted to angiotensin II which is a very powerful vasoconstrictor causes aldosterone responsible to reabsorb Na |
| if I don’t have angiotensin II, I don’t have | vasoconstriction |
| how does a beta block work for hypertension……Does it work in the heart? | No, it works in the kidneys |
| How else do we treat hypertension? | Ace inhibitors. Blocks the conversion of angiotensin I to angiotensin II. |
| What’s arb? | ARB? Angiotensin receptor blocker – yeah! Antiotensin II receptor blocker. It sits in the angiotensin II site - doesn’t allow it to work – and ARB. |
| aces, we have –arbs, we have beta blockers, how else do you treat blood pressure? | Calcium channel blockers |
| Calcium channel blockers | calcium moves into the cell, it constricts,giving calcium channel blocker, calcium is not moving into the cell,cell is not going to constrict, no vasoconstriction ,don’t have hypertension, works on smooth mm |
| diuretics treat blood pressure | pull the volume off to decrease the blood pressure. |
| how much physical activity do you need? | 30 minutes per day at target heart rate – ok… Three times a week. I think they bumped it to 5. |
Created by:
goryan
Popular Nursing sets