Advanced Med Surg - Exam 2 Module 3

Acute coronary syndrome

Sudden reduction in blood flow to the heart, progression of coronary events

Acute coronary syndrome s/s female

indigestion/feeling of fullness, chronic fatigue/can't catch breath, pain between shoulders/aching jaw, choking sensation

Acute coronary syndrome s/s male

Chest pain at rest, N/V, inc HR/BP, dyspnea, sweating, sudden weakness, pain in back neck, jaw, abdomen, shoulders, arm, tightness, fullness

Acute coronary syndrome s/s elderly

SOB #1, cold/clammy, BP drop, PVCs, vomiting, less or no pain, behavior changes

Acute coronary syndrome s/s diabetics

Neuropathy, silent MIs

STEMI recognition

cardiac injury with total occluding thrombus, elevated cardiac enzymes, ST elevation on ECG

STEMI treatment

Cath lab PCI within 90 minutes, thrombolytics

STEMI wave form changes

0 hr - ST elevation, 1-24 hr - depressed R with ST elevation (R and T almost equal), day 1-2 - T wave elevation and enlargement, days - inverted T wave, weeks - normal EKG

NSTEMI

cardiac ischemia with subtotal occluding thrombus

NSTEMI lab changes

Elevated cardiac enzymes, hypokalemia, elevated troponin

acute MI treatments

OAMN - oxygen (perfusion), aspirin (prevent clots), morphine (pain, decreased CW), nitro (vasodilation), then cath lab or clot buster within 30 mins

acute MI potential complications

HF, cardiogenic shock, arrhythmias, myocardial rupture, LV aneurysm, ventricular wall rupture, pericarditis, bleeding risk

PCI potential complications

MI, allergy to dye, retroperitoneal bleeding from site, re-occlusion

PCI nursing actions post cath

Keep catheter leg straight, bedrest 4-6 hours, check peripheral pulses, long term antiplatelet therapy

Elevated troponin

indicates heart muscle injury, >.5 = heart cell death

Elevated BNP

heart muscle stretch/fluid overload increase = heart failure

Cardiogenic shock treatments

Restore perfusion, pain relief, decreased myocardial O2 demand, nitro, milrinone - contractility, fenoldapam - vasodilator, vasopressors, IABP therapy

Would you do a fluid bolus for cardiogenic shock?

No because rapid fluids can cause fluid overload and worsen pulmonary edema from decreased functioning of left ventricle

Hemodynamics - PA cath

frequent, accurate monitoring of fluid volume (preload) or CO

Hemodynamics - CVP

central venous pressure, if elevated can indicate right sided heart failure and fluid overload (2-6 mm/Hg)

Hemodynamics - indications of fluid overload

elevated CVP

Arterial lines nursing assessment

inspect for drainage/infection, keep dressing D/I, inspect lines, transducer and stopcocks appropriate, 5 Ps, hematoma, waveform

Sinus bradycardia causes

athletes, carotid sinus massage, hypothermia, increased vagal tone, increased intracranial pressure, parasympathomimetic drugs

Sinus brady diagnosis

SA node <60

Sinus brady treatment if stable

treat underlying cause, oxygen, keep warm

Sinus brady treatment if unstable

Check bp, bed rest with O2, assess for chest pain, atropine, pacemaker

Asystole treatment

total absence of activity

CPR with ACLS, intubation, transcutaneous pacing, IV therapy, epinephrine/atropine

Premature ventricular contractions nursing assessment

may not generate a peripheral pulse, assess apical-radial pulse rate to determine pulse deficit, may convert ot v tach or v fib

Sinus tachy rhythm

>100 bpm, normal pqrst

V fib rhythm

serious rhythm, undulating waveforms of irregular and varying contour and amplitude

V fib how to defibrilate

immediate CPR/ACLS, defibrillation, epinephrine, vasopressin, amiodarone, lidocaine, magnesium

V tach rhythm

repetitive firing of irritable ventricular ectopic focus with rate of 140-250 bpm

V tach what to do first

check for pulse

if no pulse - cpr with defibrillation

if pulse and symptomatic - cardioversion and antiarrhythmics

SVT stable

normal VS, palpitations, hypotension, dyspnea, angina

SVT unstable

abnormal VS, low BP, altered mental status

SVT stable treatment

carotid massage, coughing, valsalva, chemical cardioversion with IV adenosine, radio-ablation

SVT unstable treatment

synchronized cardioversion

PEA

pulseless electrical activity

electrical activity on ECG but no mechanical activity of ventricles

CPR

A fib potential complications

loss of atrial kick and rapid ventricular response - decreased CO, thrombi formation in atria, embolus that travels to brain causing stroke

Defibrillation

pulseless v tach/v fib, countershock to depolarize myocardium to allow SA node to regain control

Cardioversion

shock used to stop irregular heart rhythm that is present in unstable SVT, a-fib, a-flutter, or tachydysrhythmias

Defibrillation/cardioversion in stable patients

pharmacological cardioversion with medication to stabilize heart rate

Defibrillation/cardioversion in unstable patients

shock to reset heart rate

Temporary pacemakers indications

symptomatic bradycardia, heart block, post MI