Level Up RN and Book Exam 1, Week 2 Content

Med Surg 2

What is an MI?

30+ min chest pain due to ischemia

What causes an MI?

Atherosclerosis= occluded blood flow

What are the primary S/S of an MI?

Chest Pain 30+ min
SOB
Diaphoresis
Dizzy

What are female S/S of MI?

Fatigue
N+V
Shoulder/Back/Jaw Pain

What are the diagnostics for an MI?

Myoglobin
Troponin I
Troponin T

What is the earliest marker for cardiac enzymes?

Myoglobin (No longer after 24 hr)

What is the range and time for Troponin I?

7-10 days

0.03

What is the range and time for Troponin T?

10-14 days

0.4

What are the two types of MI?

NSTEMI (Non-Elevated ST)
STEMI (Elevated ST)

What are the main medications for an MI?

Morphine Sulfate
Oxygen
Nitroglycerin
Aspirin

What other medications can be given with an MI?

Clopidogrel
Metoprolol
Heparin
Eptifibatide (ATE)

What are surgical interventions for MI?

PCI, CABG, Atherectomy, Cardiac Cath

What happens with a cardiac cath w/ MI?

catheter in femoral vessel
injection of contrast media

What absolutely needs to happen before a cardiac cath?

Informed Consent
NPO 8 hours

What needs to be monitored with nitroglycerin?

Orthostatic Hypotension
NO erectile dysfunction meds (24-48 hr)

How many doses of nitroglycerin at 5 minute intervals?

3 doses max (sublingual)

What is the most common adverse effect of nitroglycerin?

Headache

When taking nitroglycerin if pain is NOT relieved in 5 minutes what should you do?

Call 911 and continue taking next doses

What should you monitor when giving morphine sulfate?

Resp Depression (Less than 12 BPM)

Who should you NOT give morphine sulfate to?

Asthma and Emphysema Patients

What needs to be monitored with metoprolol?

Bradycardia and Hypotension

What needs to be done with both Metoprolol and Nitroglycerin?

Change positions slowly

Who should you NOT give metoprolol to?

Asthma patients
HR under 60 BPM

What is the biggest risk with thrombolytics?

Bleeding and Bruising

What medication should nitroglycerin be given at the same time as?

Aspirin

What is an indication of aspirin toxicity?

Tinnitus

What lab needs to be monitored with heparin?

aPTT

When should oxygen be administered with an MI?

O2 Sat under 90%

When does cardiogenic shock or failure occur?

40% blockage

What are the S/S of cariogenic shock?

Tachycardia
Tachypnea
Low UO
Hypotension
Cool/Clammy Skin
Weak Pulses

What does percutaneous coronary intervention do?

Open coronary arteries

How long after onset of MI symptoms can a PCI be done?

2 hours after onset

What happens with a PCI?

Balloon in femoral
Balloon inflated
Stent placed

After a PCI what is super important to do?

Check distal perfusion
(Color, Cap Refill, Pulses)

What are complications of PCI?

Artery Dissection/Reocclusion
Cardiac Tamponade

What are S/S of aortic dissection/reocclusion?

Chest Pain
SOB
Tachypnea
Tachycardia

What are S/S of cardiac tamponade?

Hypotension
JVD
Muffled Heart Sounds
10 mmHg BP variance

What is the treatment for a cardiac tamponade?

Pericardiocentesis (aspirate fluid)

What diagnostic tests confirm cardiac tamponade?

Chest X-Ray and Echocardiogram
(See fluid)

What medication is given prior to a stress test?

Adenosine

What is the antidote for heparin?

Protamine Sulfate

What is given before and after a PCI?

Before: Clopidogrel
After: IV Heparin

What is the leading cause of death after an MI?

Dysrhythmias

What does a PVC look like?

P wave: Normal expect before QRS
QRS: Wide and early (>0.12)

Pause before next beat

What is a CABG?

bypass one or more coronary artery

What is the criteria for a CABG?

50% blockage
Heart failure and disease
Persistent ischemia
Heart Valve Disease

What is preprocedure for CABG?

Baseline assessments
Informed Consent
Prophylactic ATBs
Diazepam/Lorazepam

What is client teaching before CABG?

Cough and Deep Breath
Splint with pillow
Arm and Leg Exercises
Early Ambulation

What is super important that the nurse does before a CABG?

Help with anxiety for patient and family

Before a CABG when should diuretics be stopped?

2-3 days before

Before a CABG when should aspirin and anticoagulants be stopped?

1 week before

What medications can be continued with a CABG?

K+ supplements
Amiodarone
Metoprolol
Insulin

What is intraop teaching with CABG?

Cardiopulmonary Bypass
Heart is stopped with cardioplegic
Pacemaker wires placed
Catheter placed
Chest tubes placed

What is a concerning drainage from chest tubes?

150+ mL/hr
Notify Provider

What is post-op teaching with CABG?

Monitor F+E
Monitor Vitals

What F+E is most important to monitor with CABG?

Potassium levels

What does hypertension cause with CABG?

Bleeding from grafts and sutures

What does hypotension cause with CABG?

graft collapse

Why is temperature control important after CABG?

Hypothermia (help w/ rewarming)

What should be given for pain for CABG?

Morphine and Fentanyl

After a CABG when should a patient be in a chair?

24 hours post-op

By day 1 post-op how far should a patient walk after a CABG?

25-100 feet (3x day)

How long after a CABG can you return to work?

week 2 (part-time)

What are common complications after a CABG?

Cardiac Tamponade
Hypovolemia
Left Ventricular HF

What is a heart healthy diet after CABG?

low fat
low cholesterol
low salt
high fiber

What are the two methods of CABG?

Saphenous= Leg Vein
Internal Mammary= Left anterior artery

What is ischemia?

insufficient oxygen

What is infarction?

necrosis or cell death

What is stable angina?

Occurs with exercise or Stress
“Strangling of Chest”

What is stable angina relieved by?

Rest or Nitroglycerin

What causes angina?

Atherosclerotic Plaque

What is unstable angina?

Occurs with exercise or rest
Increases in duration, severity, and occurrence

What is variant angina?

Coronary Artery Spasm (rest)

What is pre-infarction angina?

chest pain days or weeks prior to MI

How long does angina last?

15 minutes or less

What is super important teaching with nitroglycerin?

NO SUN
3 month shelf life

How is angina pain often referred?

Squeezing, heavy pressure, constricting

How to decipher between unstable and stable angina?

Stable= Anticipated (w/ exercise or stress)
Unstable= Random (either exercise or rest)

What diagnostics for angina?

EKG
Stress Test (Adenosine)
Coronary Angiogram

What is valvular heart disease?

abnormality or dysfunction of valve

What is stenosis?

Narrowed opening

What is insufficiency?

Regurgitation (backflow)

What are risk factors for valvular heart disease?

HTN
Rheumatic Fever
Infective Endocarditis

What happens to the heart with valvular heart disease?

Hypertrophy
Murmur
Increased pulmonary artery pressure

What are S/S of valvular heart disease?

Murmur
Extra Heart Sounds
Dyspnea
Fatigue
Orthopnea

What is unique with mitral stenosis?

A-Fib
JVD
Hepatomegaly

What is unique with mitral insufficiency?

S3 sounds
JVD
Hepatomegaly

What is unique with aortic stenosis?

S4 sounds
Angina
Narrow pulse pressure

What is unique with aortic insufficiency?

Nocturnal Angina
Widened pulse pressure
Bounding pulse
Elevated systolic

What diagnostics for valvular heart disease?

Chest X-Ray
Echocardiogram
TEE
Stress Test

What medications for valvular heart disease?

Diuretics (watch K+)
-pril
-sartan
Digoxin
Anticoagulants (Heparin)

What surgical procedures for valvular heart disease?

Percutaneous Balloon
Valve Replacement
Valve Repair

What must be given before every procedure with valvular heart disease?

Prophylactic ATBs (dental/resp procedures)

After a mechanical valve is placed what needs to be monitored frequently?

Prothrombin time

What is infective endocarditis?

Infection of the endocardium

Who is infective endocarditis common for?

Cardiac Malformations
Pacemakers
Prosthetic Heart Valve
IV substance abuse

What are the findings for infective endocarditis?

Flu-Like
Murmur
Petechiae (Mouth+Trunk)
Splinter Hemorrhage (Red Streak on nails)

What diagnostic test for infective endocarditis and pericarditis?

Echocardiogram and EKG

What is pericarditis?

Inflammation of pericardium

What are the findings for pericarditis?

Chest pressure from breathing, coughing, swallowing
Friction Rub
SOB
Relief when sitting upright or leaning forward