Cardiac Critical Care Exam

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99 Terms

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what is the definition of shock?

the lack of adequate circulation or blood supply causing inadequate oxygen delivery to vital organs causing an inability to meet cellular metabolic needs

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What are the distributive shocks?

neurogenic, anaphylactic, septic

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distributive shocks:

extreme vasodilation leading to decreased organ perfusion

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Compensatory stage:

body attempts to compensate for damage

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Which types of shocks are compensatory?

all except neurogenic

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compensatory stage entails:

normal BP, normal HR, increased RR (getting more 02 in blood) due to respiratory alkalosis, cold/clammy skin, decreased urine output, confusion

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Progressive shock stage:

no longer compensating, MAP falls <65

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Irreversible stage:

No longer responding to treatment, focus on patient's family and education

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Hypovolemic shock:

due to decreased fluid volume in vascular space

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Septic Shock:

amplified responses to pathogen causes increased capillary permeability

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cardiogenic shock:

heart loses ability to pump effectively

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neurogenic shock:

sympathetic nervous loses ability to stimulate nerve impulses

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anaphylactic shock:

hypersensitivity response leading to obstructive airway

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causes of hypovolemic shock:

internal bleeding, burns, long bone fractures, surgery, vomit, DI, diarrhea, sweating, trauma

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management of hypovolemic shock:

treat cause, fluid and blood replacement, modified trendelenburg promotes venous blood return, pharmacologic

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Nursing management:

monitor for fluid overload (2 large bore IV, foley catheter), Warm IV fluids

Oxygen: increase O2 for available hgb

Monitor all labs = ABGs, H+H

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What causes cardiogenic shock?

Acute MI, pericardial tamponade, endocarditis, dysrythmias

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S/S of cardiogenic shock:

Left: pulmonary edema, dyspnea, decreased 02, increased RR, increased HR

Right: JVD, weak pulses, chest pain

Brain : confusion, agitation, and anxiety

Kidney: RAAs activation, oliguria, increased BUN/ creatinine

Skin: decreased perfusion: cool and clammy

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Management of cardiogenic shock:

oxygen, morphine, Hemo monitoring, fluids

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Drugs for cardiogenic shock:

diuretics, pressors, dilators

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Nursing management cardiogenic shock:

Intra aortic balloon pump, check artlines, labs, breath sounds, perfusion

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risk factor for septic shock:

suppressed immune system, really old or really young people, invasive procedures, surgical pts, malnutrition, chronic illness

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s/s of septic shock:

Early: vasodilation, warm/flushed, decreased BP, increased HR, increased RR, fever, restless

Late: cold/clammy, HoTN, increased HR, Increased RR, decreased CO, oliguria, hypothermia

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Nursing interventions for septic shock:

rapid identification, broad spectrum antibiotics, nutritional supplement, fluid resuscitation, pressors, packed RBCs, DVT prophylaxis, check MAP, platelets, bilirubin, creatinine, BUN, urine output, GCS ,HR, BP, LOC, elevated temp

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Neurogenic Shock causes:

damaged cervical spine, which causes widespread blood vessel dilation

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S/S of neurogenic shock:

bradycardia, hypotension, hypothermia

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Interventions for neurogenic shock:

protect the spine, airway, maintain MAP

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S/S of anaphylaxis shock:

dyspnea, wheezing, obstruction, swelling, HoTn, <90 SBP, increased HR, itchy

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Interventions for anaphylactic shock

prevention, allergen, airway, call rapid, trendenelburg, epi, fluids, antihistamine

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MODS:

altered organ function in acutely ill patients related to s/s of progressive shock

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S/S of MODS:

lungs go first-> intubate, decreased BP, hyperglycemia, muscle loss, in 7-10 days the liver starts to fail

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interventions for MODS

catch early and support organs, family support and early communication

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When are the coronary arteries perfused?

during diastole

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When is the rest of the body perfused?

during systole

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Diastole:

relaxation and filling of the heart muscle

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systole:

Contraction of the heart

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endocardium:

epithelial tissue that lines the inside of the heart

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myocardium:

muscle fibers responsible for pumping

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epicardium:

exterior layer of the heart

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cardiac output:

total amount of blood ejected by the ventricles per minute

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stroke volume:

amount of blood ejected from ventricle per beat

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baroreceptors:

located in aorta and carotid arteries that detect changes in blood pressures

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preload:

stretch of the ventricles at the end of diastole

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afterload:

resistance to the ejection of blood from the ventricles

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contractility:

force generated from the myocardium

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P wave represents

atrial depolarization

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PR interval represents

atrial depolarization

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QRS complex represents

ventricular depolarization

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T wave represents

ventricular repolarization

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Modifiable factors

weight, diet, exercise

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CAD

coronary artery deposits is lipid deposits and fibrous tissue in the lining of the blood vessel walls

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s/s of CAD:

ischemia, angina, radiating jaw&arm pain, SOB, sweating

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risk factors for CAD:

Family hx, age, gender, race,

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modifiable risk factors for CAD:

HTN, smoking, diabetes, metabolic syndrome, obesity, inactivity, hyperlipidemia

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prevention for CAD:

control cholesterol, stop smoking, manage HTN, manage diabetes, physical activity (150 min/week)

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Angina pectoris:

any pain or pressure in the anterior chest r/t CAD

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stable angina:

caused by physical activity, predictable pain, relieved by nitro

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unstable angina:

occurs randomly, unpredictable, not relieved by nitro

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variant angina:

sometimes triggered by physical activity making it unpredictable, worsens with time, not relieved with rest

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myocardial infarction s/s

chest pain, HVD, increased BP, EKG changes, SOB, dyspnea, tachypnea, restless, cool/clammy

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diagnosis for MI

ST elevation, Q wave abnormality, T wave inversion

ECHO: to determine EF

Labs: Troponin

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treatment for MI

EKG within 10 minutes, door to balloon in 90 minutes, bed rest for 24 hours, oxygen, aspirin, nitro, morphine

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PCI (cardiac cath)

balloon/stent placement, contraindication, can start bleeding (hold pressure and contact HCP immediately)

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Mitral regurgitation

backflow of blood from the left ventricle into the left atrium

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s/s of mitral regurgitation:

asymptomatic, dyspnea, fatigue, SOB on excertion

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assess/Dx for mitral regurgitation:

murmurs, ECHO

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Tx for mitral regurgitation:

treat like LHF, reduce cardiac afterload, ACE inhibitors, ARBs, Beta Blockers

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Mitral Stenosis:

backflow of blood from left atrium to the lungs due to obstruction from LA to LV

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S/S of mitral stenosis:

asymptomatic, dyspnea, SOB, dry/wheezing cough, hemoptysis, paroxysmal nocturnal dyspnea

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ass/dx for mitral stenosis:

weak pulse, low pitched rumbling diastolic murmur, ECHO, stress test, EKG, cardiac cath

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Tx for mitral stenosis:

anticoagulants due to pooling in left atrium

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aortic stenosis

narrowing of the aorta

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risk factors for aortic stenosis:

age, diabetes, hypercholesterolemia, HTN, smoking

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s/s of aortic stenosis:

dyspnea, angina, increased pulmonary pressure, dizzy

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assess/dx of aortic stenosis:

systolic murmur heard over aortic area, vibration, s4 sounds, ECHO every 5 years, EKG, MRI every 6-12 months

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pericarditis

inflammation of the pericardium

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causes of pericarditis

infection, surgery, rheumatid fever, lupus, immune/medication rxn, radiation

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treatment for pericarditis:

NSAIDS, pericardiocentesis, lean forward, antibiotics, analgesics

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Heart failure:

a chronic condition in which the heart is unable to pump out all of the blood that it receives

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classes of HF:

systole: weakened heart muscle=decreased ability to pump

diastole: stiff heart muscle=decreased ability to fill

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causes of HF:

CAD, HTN, valve disorder, MI

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s/s of HF:

Left: pulmonary congestion, crackles, low 02, dyspnea, SOB, ventricular gallop, cough, orthopnea,

Right: JVD, edema, hepatomegaly, ascites, anorexia, decreased CO2

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assess/dx of HF:

ECHO, EKG, chest x-ray, Labs, stress test

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complications of HF:

thromboembolism and pulomary embolism= clot concern=anticoagulants

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ACE inhibitors for HF:

decrease workload, decrease preload, decrease afterload

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ARBS for HF:

decrease workload, decrease preload, decrease afterload

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Hydralazine/Isosorbide for HF:

vasodilates and decreases preload

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Beta Blockers for HF:

decreases BP, decrease afterload, decrease cardiac workload

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diuretics for HF:

remove excess fluid volume

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digoxin for HF:

decreases HR, increases contractility

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how to calculate Pulse Pressure:

SBP-DBP

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How to calculate SV:

EDV-ESV

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How to calculate CO

HR x SV

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How to calculate EF

SV/EDV x 100

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How to calculate MAP

2xdiastolic + systolic all divided by 3

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Gero considerations for Peripheral circulation:

Vessels stiffen-> increased resistance-> impair blood flow -> increased left ventricle workload -> hypertrophy -> LV ischemia

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assessment for peripheral circulation:

Health hx, physical (cap refill, blood pooling, pulses, hair, ulcers, color), palpitation (peripheral pulses, weeping, redness, edema)

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diagnostics for peripheral circulation

doppler, exercise testing, duplex ultrasounds, angiography

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PAD

peripheral artery disease