Adv Med Surg Exam 1

cardiac catheterization

most definitive and invasive test in the diagnosis of heart disease

palpitations, feeling heat/hot flash, desire to cough as medium is injected into right side

what sensations might a patient experience when going through cardiac catheterization

remain supine, keep insertion site straight, monitor VS every 15 min for 1 hour, then every 30 mins for 2 hours, then every 4 hr, assess peripheral pulses in affected extremity and skin temp/color

post-op care for a cardiac catheterization patient

NPO 4-8hr, assess for iodine/shellfish allergy (contrast media)

pre-op care for a patient undergoing cardiac catheterization

metformin

contraindication to cardiac catheterization

coronary artery blood flow

what does cardiac catheterization measure?

90 mins

what is the door to balloon time for cardiac cath?

protamine

what is the antidote for heparin?

vasovagal reaction (sudden drop in HR and BP)

what complication can happen during cardiac cath

hemodynamic monitoring

refers to a variety of monitoring techniques designed to provide quantitative information about vascular capacity, blood volume, pump effectiveness, and tissue perfusion

placed at phlebostatic axis (4th intercostal midline)

how do we know if the invasive line for hemodynamic monitoring (arterial line, CVP) is in the correct place and measuring pressure correctly?

2-8 mmHg

normal central venous pressure (CVP)

4-8

normal cardiac output (CO)

show real-time BP, not for fluid administration, draw blood for ABGs

what can an arterial line do?

endocarditis (bleeding and infection)

what is a big risk with invasive hemodynamic monitoring and what do we watch for

amount of blood returning to the heart (preload)

what is the CVP

administer fluids

what to do if the CVP is low

4-6 hours

how quickly does an MI need an intervention?

morphine, oxygen (only if 90 or lower), nitro, antiplatelets

treatment for MI (MONA)

morphine, nitro

what medications to NOT give to a patient experiencing an MI if their BP is too low

10 mins

how quickly should an ECG be obtained with reports of chest pain and possible MI

when the patient is actively bleeding out

when does airway not take priority over circulation?

furosemide, hydrochlorothiazide, spironolactone

diuretics that decrease circulating volume and are for HF with fluid overload and congestion

digoxin, dobutamine

drugs that enhance contractility of the heart

GI upset, fatigue, confusion, vision changes (yellow halos, blurred vision), bradycardia, PVCs, heart block, anorexia, N/V, dizziness, lightheadedness

signs of digoxin toxicity

with hypokalemia

when is there a higher risk of digoxin toxicity

increases HR and contractility to increase CO

what does dobutamine do to the heart

shunts blood and increases HR/BP and oxygen demand on heart

what does dopamine do

cardiogenic shock

what is dopamine designed to treat?

central

what kind of line does dopamine need to be given through?

HTN, tachycardia, ectopic beats, angina

adverse effects of dopamine

assess F&E balance, neurological status every 30-60mins

postop care for CABG surgery

1.3-2.1

normal mag levels

3.5-5.0

normal potassium levels

8.5-10.5

normal calcium levels

tachycardia, HTN, increased DTR, shallow RR, irritability/confusion, tetany/seizures, twitches/paresthesia

s/s of hypomagnesium

thready/weak/irreuglar pulse, ortho hypotension, shallow respirations, lethargic/anxiety/confusion, paresthesias, decreased DTR, constipation, N/V, abdominal distention, ECG changes

s/s of hypokalemia

necrosis in hands

what does long term use of levophed (norepi) lead to

in the last resort to keep the pt alive

when is levophed (norepi) used

tissue necrosis, sloughing if given peripheral IV, arrhythmias

adverse effects of levophed

improves mean arterial pressure by increasing peripheral resistance and increasing venous return

what does levophed do in the body

assess for chest pain, monitor urine output hourly, assess BP Q15 min (HTN =overdose), assess HA, Q30 for extravasation, extremities for color/perfusion

nursing interventions for levophed

loss of fluids or blood (hemorrhage, dehydration, vomiting/diarrhea, inadequate clotting)

cause of hypovolemic shock

30mL/kg bolus IV with isotonic/LR solution, levophed if fluids aren’t working

interventions for hypovolemic shock

direct pump failure (acute MI)

causes of cardiogenic shock

treat underlying cause, support cardiac function, NOT fluids, dopamine/digoxin

treatment for cardiogenic shock

blood flow redistribution; sepsis, anaphylaxis

cause of distributive shock

antibiotics (sepsis), fluids, treat underlying cause

interventions for distributive shock

noncardiac obstruction (cardiac tamponade most common)

cause of obstructive shock

O2, IV fluids, vasoconstrictors/inotropes, improve myocardial perfusion, pericardiocentesis (cardiac tamponade)

interventions for obstructive shock

dyspnea

what is an early sign of heart failure and may only present in females?

HTN, cardiac infections/inflammation, cardiomyopathy, dysrhythmias, valvular disease, congenital defects, CAD, family hx, hyperkinetic conditions (pump failure)

causes of left-sided HF

left-sided HF, pulmonary HTN, chronic lung disease, obesity, sleep apnea, smoking, substance misuse

causes of right-sided HF

echocardiogram

what is the best tool for diagnosing heart failure

less than 100

what is a normal BNP

when greater than 100

when does a BNP indicate HF

less than 0.04

normal troponin level

55-70

normal ejection fraction

when greater than 4, or greater than 2 after IV fluids are given

when is lactic acid concerning

mechanical

life long anticoagulation therapy with warfarin is required (INR 3.0-4.0) for this kind of valve replacement

biologic valve replacement (pig/cow)

temporary valve replacement that you may put in an 80 year old but not a 20 year old because it wont last long

mechanical valve

type of valve replacement that requires patients to be on life-long anticoagulation therapy but lasts longer

dark leafy greens/vegetables

what foods to avoid if on warfarin therapy bc they are high in vitamin K

3.0-4.0

therapeutic level for INR for a patient on anticoagulation therapy after a mechanical valve replacement

2-3

normal therapeutic level of INR

dental procedures for 6 mo

what kind of procedure should people avoid after valvular surgery and how long because of the potential for endocarditis

yes

can CNAs assist with EKG lead

atrial fibrillation

what rhythm is this?

P waves absent, regular rhythm

what does Afib look like on an EKG

assess BP/LOC, vagal maneuvers, antidysrhythmics (amio/diltizaem), cardiovert

interventions for Afib from first to last

pulmonary embolism

what are patients who have Afib at high risk for?

pericarditis

ST elevation in all 12 leads is what?

substernal precordial pain radiates to left side, pericardial friction rub

s/s of pericarditis

lower left sternal border

where is pericardial friction rub best heard at

pericardial effusion, tamponade

complications nurses need to monitor for pericarditis

flat t waves, u waves, ST depression, VT/VF risk

what does an EKG look like if a patient has hypokalemia

tall peaked T waves, widened QRS, prolonged PR, bradycardia, asystole risk

what does an EKG look like for hyperkalemia

prolonged QT, torsades de pointes

what does an EKG look like for hypomagnesemia

bradycardia, widened QRS, heart block

what does EKG look like for hypermagnesemia

prolonged QT

what does an EKG look like for hypocalcemia

shortened QT

what does an EKG look like for hypercalcemia

vfib, vtach, asystole, PEA

what are the lethal dysrhythmias

vtach

what rhythm is this

vfib

what rhythm is this

pulseless electrical activity (PEA)

what rhythm is this

p waves and t waves combined, severe tachycardia

what does SVT look like on an EKG

vagal maneuvers (blow on straw, bear down, valsalva, carotid sinus), adenosine 6mg-12mg

interventions for a stable SVT patient

brief asystole and hypotension with return to normal

what does adenosine do to the heart when pushed rapidly for SVT

cardiovert

what to do for unstable SVT

avoid magnets and transmitters, carry pacemaker ID card, med alert bracelet

patient teaching for permanent pacemakers

direclty before P wave

when do pace spikes happen before atrial programmed pacemakers?

directly before QRS complexes

when do pace spikes occur for ventricular programmed pacemakers

avoid lifting greater than 10lbs overhead for 4 weeks

activity restrictions post pacemaker insertion

sinus bradycardia

what rhythm is this

sinus tachycardia

what rhythm is this

atropine x3 every 5-15min

what med is given to stable sinus brady pts to increase HR

temporary pacemaker

treatment for unstable sinus brady

decreased CO - fatigue/weakness, oliguria/nocturia, angina, confusion/restlessness, dizziness, pallor/cool extremities, weak peripheral pulses

pulmonary congestion - hacking cough, dyspnea, crackles/wheezes, frothy pink tinged sputum, tachycardia, S3/S4 gallop

s/s of left sided HF

systemic congestion, JVD, enlarged liver/spleen, anorexia/nausea, dependent edema, distended abdomen, swollen hands/fingers, polyuria, weight gain, BP changes

s/s of right sided HF

300mg for dead, 150 for alive

how much amio to give a patient for atrial and ventricular dysrhythmia treatment