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Cardio Care

Terms in this set (104)

What is coronary artery disease?
condition where blood flow to the heart is obstructed
Define atheromas
fatty deposits that prefer coronary arteries
When are oxygen and nutrient supply to the myocardium compromised?
When arterial blockage exceeds 70%
What is the leading cause of CAD?
Atherosclerosis
What is CRP?
C-reactive protein.
Its a non-specific marker of inflammation that is typically increased in CAD patients
What is collateral circulation?
compensation for a lack of blood flow that includes arterial anastomoses (new connections in arteries that allow minor blood flow-cant handle high stress)
What is considered high blood pressure if you have diabetes?
>130/80
How are homocysteine levels related to CAD?
increased levels (found in meat) are associated with higher risk for CAD
how much fiber is recommended daily?
30 grams
What is the FITT formula?
30 mins/day, weights 2X/week
Three lipid lowering drug therapies?
Lopid, Bile acid sequestrants, Zetia
Why are health care providers moving away from prescribing drugs for high lipids and moving towards lifestyle modification?
because these drugs affect the liver
Antiplatelet therapy?
ASA first then plavix if needed
What is harm reduction?
There is benefit in less of a bad activity even if they can't stop the bad activity all together
What causes angina?
O2 demand exceeds O2 supply
What causes the pain associated with angina?
lactic acid, built up due to lack of oxygen, irritates the nerve fibers
Who wouldn't present with angina during a cardiac event?
Diabetics because they have nerve damage
What kind of pain presents with chronic stable angina?
intermittent pain, 5-15 min duration
What is silent ischemia?
ischemia that has no symptoms
ex: diabetic patients
How is silent ischemia confirmed?
ECG
What is nocturnal angina?
occurs at night
What is angina decubitus?
chest pain that occurs only while lying down and is relieved by sitting up
What is prinzmetal angina?
result of spasm of the major coronary artery-more common in women. Doesn't have anything to do with an obstruction
What could indicate prinzmetal over other anginas?
Prinz can occur when at rest whereas most others are made worse by physical activity
What is microvascular angina?
chest pain that occurs in the absence of significant coronary atherosclerosis or coronary spasm
What is the DOC for angina?
nitrates
Patient teaching for nitrates?
throw out after 3-6 months. It won't work if it expires
carry at all times
leave in the dark colored bottle
What is your first priority when administering transdermal nitrate cream?
wear gloves so you don't get any in your system
What do prinzmetal patients take?
calcium channel blockers
What is the alternative to nitrates?
beta blockers or ranolazine
What position should an angina patient be placed in?
semi-fowlers (hob 30 degrees)
What could indicate the development of a MI?
s3 or s4 heart sounds
Why is valsalvas maneuver bad for CAD patients?
it drops heart rate and puts strain on the heart
What drug could cause an MI in younger adults?
cocaine
What is acute coronary syndrome?
an umbrella term for situations where the blood supplied to the heart muscle is suddenly blocked
What is the difference between STEMI and Non-STEMI?
STEMI is total occlusion of a coronary artery whereas non is only partial. STEMI is worse
What is the goal if a patient comes in with a MI?
get them from the door to the cath lab in under 90 mins
What characterizes unstable angina?
blockage beyond 70% and plaque ruptured
What is the first line treatment for MI?
angioplasty
What is the second option for treatment of MI?
thrombolytic therapy
When do you give thrombolytic therapy?
within 6 hours of the onset of symptoms, ideally within the first hour
Why is angioplasty preferred over thrombolytic therapy?
clots can reform with thrombolytic therapy
What is the most important nursing implication when caring for a patient using thrombolytic therapy?
monitor closely for signs of bleeding, including hidden places like within the body
How do they prevent reocclusion in a patient using throbolytic therapy?
IV heparin
What are some disadvantages of coronary bypass (CABG)?
its invasive-risk for infection
it requires use of blood vessels from elsewhere-only good for about 10 years
Which two vessels are more likely to be used in CABG?
mammary/thoracic artery or saphenous vein
What are some preop implications of CABG?
teach lifestyle changes
assess neuro status
stop ASA
What should you teach a CABG patient postop?
splint wound when moving or coughing
Why would a patient with acute coronary syndrome be on stool softeners?
to avoid valsalva's maneuver
What kind of diet is appropriate for a patient with acute coronary syndrome?
low salt
low sat fat
low cholesterol
What are neurovascular checks?
Checking the extremity distal to the catheter insertion site for pulses to ensure proper perfusion. Do this on a schedule with coronary revascularization patients
What complications could the cardio-pulmonary bypass machine cause?
anemia-damage to RBCs as it goes through
electrolyte/fluid imbalances
hypothermia-blood cooled in machine
infections
Where do you want the PTTs when the patient is taking Heparin?
2-2.5x the normal
What is a pathological Q wave?
prolonged or depressed Q
What is the most common cause of MI?
complete obstruction of coronary artery
How are catecholamines affected during an MI?
They are released in response to injury
What are two systemic symptoms of MI?
N&V and fever
How can you tell where the MI occurred?
12 lead ECG
What happens in the first 24 hours after MI?
leukocytes flood the area of necrotic tissue
What happens 10-14 days after MI?
weak scar tissue forms and myocardium is very vulnerable to stress
When is necrotic tissue replaced?
6 weeks after MI
What is the number one complication after an MI?
dysrhythmias
How long does it take the entire thickness of the myocardium to become necrosed?
4-6 hours
Which abnormal heart sound is more common in an MI?
S4
What would be increased in an MI?
CK-MB (CPK)
troponin
myoglobin
LDH
Which is the best indicator of a recently past (within days) MI?
troponin-it will stay elevated for 7 days
MONA (B)?
Morphine
Oxygen
Nitroglycerin
Aspirin

and sometimes beta-blockers
Where are they trying to keep the O2 during an acute MI?
>93
What position should the MI patient be in?
semi-fowlers
What is the purpose of giving the beta-blocker to acute MI pt?
decreases O2 demand and increases perfusion
How do you remove a blockage?
angioplasty (preferred) or thrombolytics
Which allergy would prevent them from doing an angioplasty?
iodine
What is the purpose of a stent?
to keep a vessel open- more long term benefit because clots can easily reform but stent prevents that
What could indicate a bleed?
drop in blood pressure due to hypovolemia
What could indicate a brain bleed if patient is taking a thrombolytic?
severe headache
How do you know if the kidneys are being perfused?
I&O
What is the priority 72 hours post MI?
rest-heart needs to repair itself
Why are stool softeners ordered for AMI patients?
To help them avoid straining (valsalvas movement)
What could a valsalvas maneuver cause in an post-MI patient?
syncope, low blood pressure, sinus bradycardia (vasovagal reflex)
What exactly is valsalva maneuver?
forced expiration against a closed glottis
What kind of exercise should a person do after an MI?
very light, like walking
and only 5 mins at a time (but increase 5 mins every week)
they might do a stress-test first to see where they're at
What type of personality is more at risk for MI?
type A
What habit is really bad for post MI?
smoking
Post MI goals
BP < 140/90
lose weight
lowered cholesterol and glucose
How many people will have a changed sex life after MI?
75%-usually due to medication
What is the prescribed max heart rate for post MI pt?
130bpm
What is a prolapse of a valve?
when the flaps of the valve flop or bulge back into an upper heart chamber during a heartbeat. It mainly affects the mitral valve
What are some characteristics of mitral regurgitation?
low-pitched
radiates to axilla
What are some characteristics of aortic stenosis?
high pitched
radiates up neck
sounds musical
Which is worse? Systolic or Diastolic murmurs?
diastolic
What is the issue with a mechanical valve?
increased risk of clot formation on the metal. They must remain on an anticoagulant drug
What kind of tissue makes up the biologic valve replacement?
swine-pigs
-these are less durable
What is infective endocarditis?
infection of the inner layer of the heart, including cardiac valves
Rx:antibiotics
Who is most likely to get infective endocarditis?
people who already have heart problems
How is gum disease linked to cardio problems?
Infected gums are a portal of entry for bacteria that are then able to travel to the heart
What is the subacute form of infective endocarditis?
pt had a preexisting valve disease and the disease takes a longer clinical course
What is the acute form of infective endocarditis?
pt had healthy valves. Onset of disease is rapid
Which bacteria are more likely to cause infective endocarditis?
strep or staph
What is the pathophysiology of infective endocarditis?
occurs when blood turbulence within the heart allows causative organisms to infect previously damaged valves. Dead microbes build up causing vegetation that could break off (emboli)
What are the risk factors for infective endocarditis?
think vascular
-IV drug use
-prosthetic valves
-intravascular devices
-renal dialysis
How do you test for infective endocarditis?
echocardiogram (look for vegetation)
blood cultures
What are some unique vascular manifestations of infective endocarditis?
oslers nodes
janeways legions
roth's spots
splinter hemorrhages in nail beds (black line)
petechiae
If a patient with a history of infective endocarditis is going through a procedure, what might the HCP do?
prescribe prophylactic antibiotics
How do they treat a patient with infective endocarditis?
4-6 wks of antibiotics. Usually given through pic line
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