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CARDIAC
CARDIAC PT 1
| Question | Answer |
|---|---|
| What is Atherosclerosis? | A disease of the arteries where fatty deposits (PLAQUE) build up on the inner walls of blood vessels |
| What are some causes of Atherosclerosis? (Modifiable Factors) | High blood pressure, smoking, or diabetes -Cholesterol and fats stick to the damage area -WBC move in a create inflammation - The Artery narrows and stiffens, reducing blood flow |
| What happens if plaque ruptures in the body? | It can form a blood clot (Thrombus) that completely blocks blood flow |
| Signs and Symptoms of Atherosclerosis? | Heart - Chest pain or heart attack Brain -Stroke symptoms (Weakness & Confusion, Slurred Speech Legs- Pain when walking (Claudication), cold feet, sores that don't heal |
| What Diagnosis can help to determine Atherosclerosis? | Blood Test (Cholesterol, Triglycerides) EKG Ultrasound Angiography CT or MRI |
| What are some changes a patient can do to make Atherosclerosis avoidable? (Mnemonic CALM Heart) | Change lifestyle-diet and exercise, quit smoking Antiplatelet drugs- Aspirin Lower Cholesterol (Statins) Manage BP & Diabetes Heart procedures -angioplasty, stent, bypass surgery |
| Nursing considerations that can help a patient avoid Atherosclerosis | Monitoring the patient BP, cholesterol, and circulation Support diet changes and exercise Monitor chest pain or leg pain Watch for signs of stroke |
| What are some non-modifiable risk factors for Atherosclerosis? | Age Gender (Sex) Family History Genetics Ethnicity |
| What are Triglycerides? | A type of fat (lipid) found in your blood. |
| High Triglycerides contribute to what type of cause? | Atherosclerosis, this increases the risk for heart attack, stroke and pancreatitis |
| Normal Ranges to Borderline high Triglycerides levels | Below 150 is normal 150-199 Is borderline high |
| High to Very high ranges for Triglyceride levels | 200-499 High - increases risk for atherosclerosis and heart disease 500 or Higher - Dangerous risk for pancreatitis and heart attack |
| Nursing considerations for a patient with triglycerides | Teach low fat, low sugar diet Encourage exercise - helps burn triglycerides Limit alcohol Fibrate or omega 3 medications Monitor for pancreatitis: Severe abdominal pain, N&V |
| What is HDL ? | "Good Cholesterol" Name: High Density Lipoprotein |
| What is LDL? | " Bad Cholesterol" Name: Low Density Lipoprotein |
| Ways to improve LDL Levels | Eat less saturated/ trans fats Take Statins Quit Smoking Lose excess weight |
| Ways to Raise HDL levels | Exercise regularly Eat healthy fats (Fish, olive oil, nuts) Quit smoking Maintain healthy weight |
| How to place a 5 lead ECG Placement? | White (RA)- is Right Black (LA)- is Left Red (LL)- is Left leg Green (RL) Right leg Brown (V)- Chest White on Right, Smoke over Fire, Brown in the middle |
| What is a MI? | "Myocardial infarction" Death of heart muscle due to lack of oxygen from block coronary arteries |
| What are some Signs and Symptoms of a MI? | Chest pain or Pressure- "Crushing", Squeezing, Tightness, Elephant sitting on my chest. "Pain may radiate to arm, neck, jaw, or back" Shortness of breath Diaphoresis N/V Fatigue / Weakness Anxiety Pale or ashen skin Hypotension |
| What are some Atypical (SILENT) MI Symptoms? | Fatigue or weakness Epigastric pain Jaw, Neck, or back pain No chest pain at all Dyspnea "These signs are often seen in Women, Elderly, and Diabetics" |
| What Nursing Actions that will help with a MI? Think M.O.N.A | M-morphine O-oxygen (Increase O2 delivery to heart) N-Nitroglycerin A-aspirin (Prevents clotting) |
| If a patient reports chest pain unrelieved by rest or nitroglycerin lasting 20 mins. What is the "PRIORITY" response? | 1. Call Rapid Response/ Activate EMS 2.Prepare MONA |
| Priority Order (real-life sequence) includes: | 1. Oxygen 2. Aspirin 3. Nitroglycerin 4. Morphine |
| What may the patient look like if they are having a MI? | Pale, cool, clammy skin Diaphoresis (Sweating) Shortness of breath Anxious/ Restless N/V |
| What is Reperfusion Therapy? | This is the restoring of blood flow! Goal: Open the blocked artery ASAP!! |
| When do you use Thrombolytics like tPA, "Alteplase", Reteplase | Within 6 hours of symptom onset Goal: Dissolve Clot & Monitor for bleeding |
| What is the time frame for a PCI? (Percutaneous Coronary Intervention) /AngioPlasty + Stent | Preferred treatment if available within "90" Minutes of arrival Monitor for: Chest pain return Bleeding at site Arrhythmias |
| Why would the doctor need to perform a CABG? (Coronary Artery Bypass) | Surgical revascularization if the PCI fails or multiple Blockages |
| Mnemonic to Remember Post-MI Care. "HEART" | H-Heart monitoring E- Evaluate Pain (report recurrence immediately) A- Administer oxygen and meds R- Rest and reassure T- Teach life style changes |
| If chest pain persists after 1 Nitroglycerin dose. What are the next steps a person should take? | Stop Activity Sit down Call 911 Never wait or drive yourself to the hospital! |
| When should you not give nitroglycerin to a patient? | 1. Low Blood pressure Why? Because Nitro cause Vasodilation, it lowers BP and can lead to shock |
| Do not give Nitroglycerin if the MI involves the Right Ventricle! | Why? The right side depends on venous return (preload). Nitro decreases preload causing severe hypotension and decreased cardiac output |
| Nitroglycerin cannot be mixed with what type of Drugs? | Erectile Dysfunction (ED) Medications 1.Sildenafil (Viagra) 24 hours 2.Vardenafil (Levitra) 24 Hours 3.Tadalafil (Cialis) 48 hours Both medications are vasodilators-combined can cause life threatening hypotension and cardiac collapse |
| Can a patient with Severe anemia, head injury, or cerebral hemorrhage take Nitroglycerin? | NO! Nitro worsens cerebral vasodilation and increases ICP also decreases oxygen delivery |
| How Many minutes do you have to get to the Cath Lab if you have a STEMI? | 90 Minutes |
| What is a STEMI? | ST-Elevation Myocardial Infarction Means a coronary artery is completely blocked No blood or oxygen is reaching that part of the heart |
| If A patient needs to be transferred to a PCI facility because of a STEMI. What is the total time frame that the patient may have? | 120 Minutes Total! If the hospital doesn't have a Cath Lab the patient should be transferred immediately to one that does within this time frame |
| What is the Nursing Role Before a patient is sent to the Cath lab ? | Activate the STEMI team Obtain ECG within 10 minutes of arrival Administer MONA Establish IV access Draw Labs - Troponin, CK-MB, Electrolytes, coagulation Keep patient NPO Explain procedure, monitor vital signs, and rhythm continously |
| What are Thrombolytic Medications used for? | These are Clot Busters!!! These drugs dissolve the clot blocking the coronary artery when a Cath lab (PCI) isn't immediately available |
| What are common Thrombolytic Drug Names? | Streptokinase Alteplase (tPA) - (Activase) |
| Never give Thrombolytics if the patient is experiencing what Contraindication? | Active internal Bleeding- These drugs cause major bleeding History of Hemorrhagic Stroke Recent head trauma or Surgery Sever uncontrolled hypertension |
| If a patient presents with chest pain + ST elevation on ECG what is the main priority? | Reperfusion therapy ASAP !!! |
| How much time do you have to reverse ischemia pertaining to the heart? | In Early Phase. 0-20 Minutes Heart muscle is still viable (Not dead yet) If the circulation is restored withing this time frame the damage can be reversed, without infarction |
| Remember 10-30-90-120 !!! | 10- Get ECG 30- Give tPA (if no Cath Lab) 90- PCI balloon inflation 120- Max Goal from symptom to reperfusion |
| What type of medications will a patient most likely have to take after Reperfusion | Beta Blockers Ace inhibitors Antiplatelets-Aspirin Statins Heparin |
| When to Draw Troponin and CK-MB labs: After a patient has had an MI? | At admission (Baseline) Repeat in 3-6 hours Than 6-12 hours later A rise and fall pattern confirm MI |
| How do you remember which labs need to be drawn if a patient has had a MI? "3 C's + T" | C- CK-MB C- Cardiac Troponin C- Chemistry (Electrolytes) T- Triglycerides/ Lipids |
| What is the most critical Lab if a patient has an MI? | Troponin |
| What is a (EF) Ejection Fraction? | Is the percentage of blood pumped out of the left ventricle with each heartbeat. |
| What is the Normal Range of an Ejection Fraction? | 50 - 70% Meaning the heart pumps out 50-70% of the blood in the ventricle with each beat |
| How is the (EF) Ejection Fraction measured? | Via Echocardiogram (echo) Sometimes MRI or Nuclear imaging |
| What is an Echocardiogram? | A noninvasive imaging test that uses ultrasound waves to create moving pictures of the heart |
| What is the purpose of a Echocardiogram? | Shows the structure and function of the heart |
| Your completing a EKG for a patient with Chest Pain - What do you need to look for? | St-segment elevation (STEMI) - Acute MI ST-segment depression- Ischemia or reciprocal changes T-wave inversion- Ischemia Pathologic Q waves - Previous MI |
| What are some nursing considerations that will need to be done for a patient in need of a EKG? | -Immediate assessment for chest pain: Should be done within 10 min -Monitor continuously for arrhythmias -Compare with previous EKG if available -Look for ST changes, T-wave changes, or new bundle branch blocks |
| What happens if your EKG is negative? | No Acute ischemia No Arrhythmias No obvious conduction problem Negative do not mean rule out heart problems, especially in early heart attacks. |
| Why a Negative EKG Doesn't Always Mean Safe? | -Ischemia may transient or not reflected on EKG -Lack of Location of the MI -Small vessel or early occlusion -May be presented as a NSTEMI |
| What is a NSTEMI? | a type of heart attack where a partial blockage of a coronary artery reduces blood flow to the heart muscle. |
| What are the Symptoms of a Female that is having a MI? | Atypical symptoms (Fatigue, indigestion, Jaw pain, back pain) Often delay care (Mistake symptoms for GI upset or stress) |
| What are some Laboratory tests and diagnostic tests that help determine a STEMI and NSTEMI? | 1.Troponin, CK-MB, Myoglobin 2. BMP (Basic Metabolic Panel) 3. CBC (Hemoglobin, WBC, Platelets) 4.. Chest X Ray 5. ECG |
| How should a nurse assess a patient that may be suspected of having a MI? | 1. ABC's First (Airway, Breathing, Circulation) , Vital Signs 2. Symptom assessment (Chest pain, Location, Duration & Onset) check for dyspnea, diaphoresis, N/V, anxiety, palpations 3. Fatigue, indigestion, back/jaw pain especially in women |
| What are some "Red Flags" Despite having a Negative EKG, may indicate that the patient may have an underlining trouble with his heart? | Persistent chest pain Shortness of Breath Dizziness, syncope Sweating, N/V New arrhythmias |
| What is Troponin and why is it important? | A protein found in the heart and skeletal muscles that regulates muscle contractions Can detect small heart attacks that may not show on EKG. Helps differentiate cardiac chest pain from non-cardiac causes (like reflux, musculoskeletal pain). |
| When a patient is having an acute MI, troponin starts to Rise to different levels. What are the time frames in which it rises? | 3-6 hours after heart injury Peak: At 12-24 hours Return to normal in 7-14 days |
| What are some Symptoms that may cause Troponin to become elevated? | Heart failure Pulmonary embolism Sever infection/ Sepsis Kidney failure |
| What is CPK-MB? | An enzyme found in heart muscle tissue. |
| Why is CPK- MB important? | Rises when heart muscle is damaged. It helps diagnose an acute MI (heart attack) |
| What is the timeline of CK-MB in a Myocardial Infarction? | 3-6 Hours- begins to Rise 12-24 hours- Peaks 2-3 Days Returns to Normal |
| What is CABG? | A surgical procedure that bypasses blocked coronary arteries using a graft from another blood vessel |
| What are the 3 Stages of Angina? | Stable, Unstable, Variant |
| What is Stable Angina? "Normal Life" | Atherosclerotic plaque → fixed narrowing of coronary arteries This is normally predictable, occurs with exertion or stress |
| What is Unstable Angina? | Plaque rupture or clot → partial occlusion Unpredictable, increasing frequency or severity, may occur at rest |
| What is Variant (Prinzmetal's ) Angina? | Coronary artery spasm "Occurs at rest, often at night, cyclic pattern" -Patients often use Calcium channel blockers -Tends to be in Women |
| Nursing Interventions for Stable Angina: | Teach rest & nitroglycerin use Encourage lifestyle modifications |
| Nursing Interventions for Unstable Angina: | Immediate medical evaluation (risk for MI) Administer oxygen, aspirin, nitroglycerin, morphine as ordered Continuous cardiac monitoring |
| Nursing Interventions for Variant Angina: | Administer nitroglycerin or calcium channel blockers Avoid triggers (cold exposure, smoking, stress) Monitor for arrhythmias |
| Beta Blockers (“-LOL”) | Drug Names: Metoprolol, Atenolol, Propranolol, Carvedilol *Block beta-adrenergic receptors in the heart. *↓ Heart rate (HR), ↓ contractility, ↓ BP. *Reduces myocardial oxygen demand → used in hypertension, angina, heart failure, and post-MI. |
| ACE Inhibitors (“-PRIL”) | Examples: Lisinopril, Enalapril, Captopril, Ramipril |
| What are STATINS? | Statins are cholesterol-lowering medications Common Statins include: Atorvastatin, Simvastatin, Rosuvastatin, Pravastatin, Lovastatin. |
| What are some Contraindications/ Cautions when a patient is on Statins? | Can worsen liver function Liver toxicity Risk Not safe for women who are pregnant Avoid antifungals, macrolide antibiotics, fibrates Dont take if history of muscle disorders can cause (myopathy) |
| What is the maximum dose a person can take with nitroglycerin before having to call 911? | 3 in 15 minutes |
| What is the side effects of Niacin: | Skin flushing, causing warm & redness, tingling and itching on face, neck and chest |
| What happens if the patient goes in for a CABG and it fails? | The patient will Code |
| Facts about Beta Blockers "Metoprolol": | -Good for remodeling -Lowers BP - In females, causes a high death rate due to MI symptoms |
| What are fundal changes due to hypertension? | Narrowing of the retinal arterioles, changes at arteriovenous crossings, and leakage of blood of plasma |
| Primary Hypertension also known as Essential hypertension is hard to diagnose because: | A condition characterized by persistently high blood pressure without an identifiable underlying cause Causes: -Genetics -Lifestyle -Age -Medical conditions: Ex. Kidney Disease |
| Secondary Hypertension is caused by; | A medical condition that can cause high blood pressure Ex. Kidney, artery, heart, or endocrine system problems |
| What is Angina? | Chest pain or discomfort that occurs when the heart muscle does not receive enough oxygen-rich blood |
| What is the main cause of Angina? | Coronary artery disease, where the heart arteries become narrowed or blocked by buildup of fatty deposits called: "Atherosclerosis" |
| The Facts about Lisinopril include | -Used for cardiac Remodeling, if you have scar tissue it decreases it -Causes a cough -Raises potassium -Not good for African Americans |
Created by:
LorrenIsrael