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N434 Exam 1 Flashcards

Terms in this set (58)

What are non-modifiable risk factors for acute coronary syndrome (ACS)?
- Increasing age
- Women more common until 75
- White men more than black men
- Genetics, family hx of heart disease
What are modifiable risk factors for ACS?
- High total cholesterol
- High triglycerides
- High LDL
- Low LDL
- High BP (>140/90)
- Diabetes
- Tobacco use
- Physical inactivity
- Obesity
- Psychological state (stress)
What is the PQRST assessment of angina?
P- Precipitation events
Q- Quality of pain
R- Radiation of pain
S- Severity of pain
T- Timing
What are the 3 cardiac enzymes? Which is the most cardiac specific? Which shows up the earliest?
1. Troponin
2. CK-MB
3. Myoglobin

Most specific = troponin
Earliest = myoglobin
In what position should the patient be for an echo?
On left side lying position
What drug is given during a pharmacologic echo to stimulate physiologic exercise?
Dobutamine
What is a TEE? What are some nursing considerations?
Transesophageal echo -- scope passed down patient's esophagus to get ultrasound images

- Most accurate
- NPO status 6 hours before (numbing spray)
- Need informed consent!
What should a patient be educated about before an exercise stress test?
- No caffeine or alcohol 24 hours before test
- No smoking 3 hours before test
- NPO for 2 hours before test
- May need to hold certain meds (e.g. beta blockers)
In cardiac catheterization, does the catheter go into a vein or an artery? Which specific one?
Artery -- radial or femoral
Describe pre-procedure nursing care for a cardiac cath procedure.
- NPO, allergies, consent, labs
- Give fluids, sedatives, valium
- CMS (check extremity distal to site before & after)
What should the patient be educated about before a cardiac cath procedure?
- May feel hot flash when dye is injected
- May feel fluttering as catheter advances
- Cough to help catheter advance (vagal)
What position should the patient be in after a cardiac cath procedure?
Flat on back for 6 hours
What med should be kept at the bedside after a cardiac cath procedure?
Atropine -- to help get HR/BP back up if vasovagal response occurs
What is an electrophysiology study? Where are the catheters placed?
- 3-5 different catheters all at different insertion sites (VEINS)
- Know exactly which part of heart is causing the problem
What is catheter ablation? When is it used?
Damage parts of heart intentionally to create scar tissue & stop abnormal electrical pathways in tissue

Used for last-resort!
What does MONA stand for?
Morphine
Oxygen (2-4 L n.c.)
Nitroglycerin
Aspirin
What are some interventions for patients with complaints of chest pain?
- 12 lead EKG within first 10 min
- Labs (troponin)
- IV access
- Chest x-ray
- Decrease anxiety
- Minimize physical activity
- Diet (low fat, low salt)
- Stool softener to reduce strain
- Pain meds
What is the most significant contraindication for fibrinolytic therapy?
Recent stroke!
What is the primary invasive treatment for ACS?
Percutaneous coronary intervention (PCI) within 90 min of arrival
What are important nursing considerations for PCI therapy?
- Hypercoaguable state occurs around stent placement -- need oral anticoagulants
- Bed rest & relaxation
- Risk for artery rupture or perforation (& tamponade)
What is transmyocardial laser revascularization?
Used for INOPERABLE heart disease with persistent angina & unrelieved by other revascularization methods

Use laser to make tiny channels through heart muscle & into L ventricle
What artery is used in a CABG? What vein?
Artery = left internal mammary artery (LIMA)

Vein = saphenous vein
How do a traditional CABG & minimally invasive CABG differ?
Traditional:
- Need heart-lung bypass pump
- Thrombus, hypothermia

Minimally invasive:
- NO bypass or sternotomy
- Many small incisions
- Small thoracotomy
- Can't use if several arteries are blocked!
What is involved in nursing care of CABG?
- Extubate ASAP
- Incentive spirometer & splinting
- Hemodynamic & electrolyte monitoring (Swan Ganz catheter, volume expanders, arterial line, Foley)
- Rhythm monitoring
What rhythm is common post-CABG?
A fib
What are the 3 phases of cardiac rehab?
1 = Hospital

2 = Early recovery (2-12 weeks in outpatient facility)

3 = Late recovery (long-term management - home, gym, etc.)
What is some patient education regarding risk management of ACS?
- Cut back smoking
- Diet low in sat fats & high in complex carbs & fiber
- Statins for lowering lipids
- Lose weight
- Resume sexual activity within 7-10 days, prophylactic nitroglycerin
What are complications of ACS?
1. Rhythm disturbance
2. Heart failure, pulm edema, cardiogenic shock
3. Pericarditis/Dressler syndrome
What are s/s of pericarditis?
Pericardial friction rub, chest pain, dyspnea
What is tx for pericarditis?
- NSAIDs & rest
- HOB at 45 degrees
What are two complications of pericarditis?
1. Pericardial effusion
2. Cardiac tamponade
What are s/s of pericardial effusion or tamponade?
Hypotension, dyspnea, increased CVP, increased HR
What is pulsus paradoxus?
When the BP > 10 mmHg on expiration than on inspiration
What is a pericardiocentesis? A pericardial window?
Pericardiocentesis = use needle & catheter to remove fluid from pericardium

Window = Surgical removal of small part of pericardium to let excess fluid drain from sac
What does central venous pressure (CVP) measure?
Right ventricular preload
What does a high CVP mean? Low CVP?
High = fluid excess
Low = hypovolemia, vasodilation
What does pulmonary artery pressure (PAP) measure?
Right ventricular afterload
What does systemic vascular resistance (SVR) measure?
Left ventricular afterload
What does pulmonary vascular resistance (PVR) measure?
Right ventricular afterload
Which is higher before birth - PVR or SVR?
PVR before birth

SVR after birth
What are indicators of left ventricular afterload?
SVR & BP
What are indicators of right ventricular afterload?
PVR & PAP
What is the zero reference point for a trandsucer?
Atmospheric pressure
In what position are transducer readings NOT considered accurate?
Lateral lying
What is Allen's test?
Test for patency of ulnar artery prior to placing a radial arterial line

- Pressure applied over both ulnar & radial arteries to occlude them while fist is clenched
- Hand opens & should appear blanched
- Ulnar pressure released -- color should return within second (if not -- test abnormal & ulnar artery supply not sufficent to hand)
What is Frank Starling's Law?
Increased pre load will increase cardiac output.

The harder we stretch cardiac muscle the harder it will contract.
What is preload?
Volume of blood in ventricles at end of diastole
What is afterload?
Resistance left ventricle must overcome to circulate blood
What is the difference between genetics & genomics?
Genetics = individual genes
Genomics = ALL genes
What does GINA NOT cover?
- Life insurance
- Long-term care
- Disability insurance
What are 2nd-degree relatives?
Grandparents
Aunts/uncles
Nephews/nieces
Half-siblings
What are 3rd degree relatives?
Great grandchildren
Great grandparents
First cousins
CYP2D6
Codeine -- ultra-rapid metabolizers
CYP2C9
Warfarin -- poor metabolizer
What genotype of CYP2C19 for clopidogrel gets standard dosing? Alternative dosing?
Standard = 1/1
Alternative = 2/8
What are the top users of precision medicine?
1. Oncology
2. Psychiatry
3. Infectious diseases
What are genetic red flags?
- Groups of congenital anomalies
- Early onset of disease
- Neurodevelopmental delay or degeneration
- Extreme pathology (e.g. multiple primary cancers)
- Surprising lab results that don't fit clinical picture
- Family hx of disease
- Multiple generations affected
- Sudden cardiac death in an individual considered healthy
Which cells in your body contain the insulin gene?
ALL nucleated cells
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