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Cardiovascular Alt.
Nursing Management of Cardiovascular Alterations
| Question | Answer |
|---|---|
| Risk factors for CAD | Heredity, gender, age, DM, obesity/overweight, smoking, inactivity, elevated, HTN |
| ABCDE of CAD treatment | A - Antianginal drugs, aspirin B - Beta blockers, BP C - Cholesterol, cigarettes D - Diet, DM E - Education, exercise |
| What is angina? | Ischemia of cardiac muscle |
| What is the difference between stable and unstable angina? | Stable is relieved by NTG and unstable is not. |
| What is the cause of Prinzmetal's angina? | Coronary artery spasm - NOT occlusion of coronary due to atherosclerosis |
| Class I of Unstable angina | Pain with strenuous activity |
| Class II of unstable angina | Pain with ADLs with some limitations |
| Class III of unstable angina | Pain with ADLs with marked limitations |
| Class IV of unstable angina | Pain with any activity and/or at rest |
| Tx of Prinzmetal angina | Ca+ channel blocker |
| Definition of myocardial infarction | Ischemia and death of myocardium from occlusion of coronary arteries |
| Complications of MI | Dysrhythmias HF Ventricular Septal Papillary muscle rupture Thromboemboli Pericarditis Shock |
| Definition of MONA for Tx of MI | M - Morphine (Sedate & Vasodilate) O - Oxygen (Incr. O2 Sat) N - Nitrates (Vasodilate) A - Aspirin & Analgesics (Decrease Aggr.) |
| PQRST acronym for assessment of myocardial pain (Male vs. Female) | P - Palliatives or provocation Q - Quality R - Radiation and region S - Severity T - Time and treatment |
| Purpose of chest x-ray with MI? | Differential dx between aortic aneurysm and MI |
| True or false: Chest pain post stent is abnormal. | True. Indicative of reocculusion of artery or stent. |
| Name the areas (zones) involved with MI. Which are recoverable? | Ischemia Injury - Recoverable Infarction - Death (nonrecoverable) |
| T wave changes with ischemia that is seen minutes or hours after episode? | T wave elevation. Followed by T wave inversion |
| EKG changes seen with myocardial injury and for how long? | ST segment elevation. Lasts for days. |
| When are small q waves normal? | In leads I, AVL, V5, V6, small q waves are normal |
| Size of pathological Q waves | Larger than one box |
| CK enzyme post-MI | Rises in 2-6 hours Peaks in 18-36 hours Elevated for 3-6 days |
| CK-MB enzyme Post-MI | Specific for MI Rises in 4-8 hours Peaks in 15-24 hours Elevated for 2-3 days |
| Troponin I and T Post-MI | Highly specific for myocardium damage Rises in 1 hour Peaks in 10-24 hours and remains for weeks |
| When assessing LDH isoenzymes, what results are specific for myocardial damage? | When LDH1 is greater than LDH2 |
| Myoglobin enzyme Post-MI | Elevated 30 minutes to 1 hour |
| Properties of myoglobin | Released from ischemic muscle but is not specific to myocardial tissue. Elevates early Myoglobin elevates before CK |
| Properties of CK | CK is not specific for cardiac muscle Rises in 2-6 hours Peaks in 18-36 hours Elevated for 3-6 days |
| 4 days Post-MI, which enzymes will be elevated? | CK-MB Troponin I and T |
| 2 days Post-MI, which enzymes will be elevated? | CK CK-MB Troponin I and T |
| 2 hours Post-MI, which enzymes will be shown? | CK CK-MB Troponin I and T Myoglobin |
| 1 hour Post-MI, which enzymes will be shown? | Troponin I and T Myoglobin |
| 1 week Post-MI, which enzymes will be shown? | Troponin I and T |
| MI skin manifestations | S/S of decreased CO - diaphoresis - coolness |
| MI CV manifestations | Pulse deficit Abnormal rhythm Abnormal sounds JVD Edema Varicosities |
| MI Respiratory manifestations | Cough Sputum Breath sounds Nutrition Ascites (HF) |
| MI GI manifestations | Ascites Diminished Bowel sounds |
| MI GU manifestations | Decreased urinary output |
| What is PTCA | Cardiac catheterization (Balloon Angioplasty) |
| How do fibrinolytics and thrombolytics work? | Lyse thrombi by converting plasminogen to plasmin causing fibrin to break down into fibrinogen |
| What are the target times and outcomes of fibrinolytic therapy? | 2-3 hours = maximum myocardial survival 6 hours = moderate myocardial survival 12 hours = Marginal myocardial survival. |
| What is commonly seen with newly reperfused myocardial tissue? | - Reperfusion releases oxygen free radicals and cellular swelling occurs. - Tissue swelling R/T ischemia may prevent reperfusion - Reperfusion arrhythmias - PVC primarily, VT and AV block also |
| Contraindications for fibrinolytics | 12 hours out from MI Known neoplasm Pregnancy and postpartum Hemorrhagic stroke within 3 months Active bleeding BP greater than 200/120 Post CPR Recent surgery, head trauma Allergy to med Trauma or surgery within 2 weeks |
| With fibrinolytic therapy, where will you want to assess for bleeding on the patient? | Injection site Retroperiotoneal Back |
| What drugs can be given to an MI patient to decrease their myocardial O2 demand? | Beta blockers Morphine |
| How can you decrease cardiac workload in a patient with heart failure? | IABP VAD (Ventricular Assist Device) Biventricular pacing (Correct A. Fib.) Rest |
| Which kind of aortic aneurysm is more critical than the other and why? | Thoracic aortic aneurysm is more critical since it can bleed out much quicker than an abdominal aortic aneurysm. |
| What is the minimum MAP to perfuse the heart? | 60 mmHg |
Created by:
keelerd
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