ADVANCED MED SURG WEEK 2

Cardioversion

defibrillation technique using low-energy shocks to reset the heart's rhythm back to its normal pattern

-for "alive people" (for A. fib)

-only delivers energy on the R-wave

-SYNCHRONIZED with patient's ECG strip

-press and hold the shock button on R-wave

Defibrillation

application of an electric shock to the myocardium through the chest wall to restore normal cardiac rhythm

-for "dead people" (V. fib)

-do not need to hold shock button

-UNSYNCHRONIZED

implantable cardioverter defibrillator (ICD)

electrical device implanted in chest cavity with electrodes to heart; applies shock to heart to stop potentially life-threatening arrhythmias such as fibrillation or tachycardia

-patients cannot drive, swim, or do heavy lifting

ST depression = __________

ischemia (decreased oxygen to myocardium)

ST elevation = __________

myocardial infarction

Assessment for cardiac dysrhythmias:

-always assess for causes: electrolyte imbalances, what medications they are taking, and stress/anxiety levels

-physical assessment: pale/clammy skin, JVD/fluid retention, heart sounds, BP/pulse pressure

complications of dysrhythmias:

HF, cardiac arrest, or thromboembolic events

the patient's physiological causes/conditions should always be considered before their psychosocial conditions. True or false?

true

(ex: never assume chest pain is "just anxiety") --> always assume it is something physiological until proven otherwise

____________ is the number one cause of ischemic stroke

A. fib

what is the first thing to assess if a patient has ALOC?

their oxygen status

what is the "6 minute walk test?"

Patients walk as far & as fast as they can in a 6-minute period (to test their hearts response to the stress before discharge)

permanent pacemakers are primarily for __________ and __________

MI's and third degree AV blocks

complications of pacemaker use:

infections, bleeding, dislocation of lead, cardiac tamponade, and pacemaker malfunction

Coronary Atherosclerosis/CAD:

WHAT: blockages (due to abnormal accumulation of lipids) and narrowing of the coronary vessels reduce blood flow to the myocardium

S/S: ischemia, chest pain, epigastric pain, SOB, MI, and/or HF

INTERVENTIONS: manage cholesterol (lipitor), healthy diet changes, physical activity, cessation of smoking, statins, antiplatelets, or antihypertensives, and if needed, PCI

Angina

WHAT: Pain in the heart region caused by lack of oxygen

Stable--> stops with rest

Unstable--> continues with rest

S/S: severe chest pain/SOB

INTERVENTIONS: MONA

(morphine--> 1-2mg, oxygen, nitroglycerin for vasodilation, and aspirin as a antithrombotic)

Acute coronary syndrome (ACS)

WHAT: acute onset of myocardial ischemia that can lead to MI

S/S: chest pain, SOB, diaphoresis, N/V, palpitations, dizziness/syncope, and fatigue

INTERVENTIONS: MONA--> morphine, oxygen, nitroglycerin, and aspirin; cardiac ECG monitoring, and beta blockers, statins, or ACE inhibitors, and patient education on lifestyle

Myocardial infarction

WHAT: the complete occlusion of one or more coronary arteries caused by plaque buildup (heart attack) which leads to tissue death

S/S: chest pain (may radiate to jaw/left arm) (atypical signs in women such as fatigue), SOB, paleness, tachycardia/tachypnea, and elevated troponin levels/ST elevation on ECG

INTERVENTIONS: MONA (morphine, oxygen, nitro, and aspirin)

-must go to Cath lab for a coronary artery stent placement

coronary artery bypass graft (CABG)

WHAT: an invasive procedure where a graft (a blood vessel from another part of the patient's body) is placed to reroute blood flow bypassing a blockage in an occluded coronary artery (done for an MI)

POST-OP: monitor BP, temperature, and bleeding

PT. ED: cessation of smoking, exercise regularly, and follow a healthy diet

percutaneous coronary intervention (PCI)

WHAT: balloon-tipped catheter is inserted into a coronary artery to open the artery; stents are put in place to restore blood flow to the myocardium (for ACS, unstable angina, or STEMI)

POST-OP: monitor for bleeding/infection, bedrest (keep femoral site or radial site immobilized), assess distal pulses, and monitor vital signs

PT. ED: must take anti platelets (do not stop), no heavy lifting, stress management, cessation of smoking, and a healthy lifestyle