Acute Myocardial Infarction complications
What is the most frequent complication of AMI?
-Dysrhythmias (PVC's very common)
-Bradycardias and AV blocks (hypoperfusion)- common with right infarction
(monitor HR, BP, perfusion- may require pacemaker)
What are some s/s of left sided heart failure?
-Crackles, cough, dyspnea
-S3 gallop, weak pulses
-Mentation changes
What is the measurement of cardiac output and what is the purpose of cardiac index?
-Cardiac output: HR x SV
normal is 3-6L/min
-Cardiac index: index for size, better indicator of cardiac performance
What is the allens test used for?
-Adequate artery/blood flow for lab tests (ABG's)
What is an infection in the line called?
CLABSI
What does an assessment consist of in a patient with pericarditis?
-Chest pain (acute and sharp, worse on inspiration, relieved by leaning forward)
-Pericardial friction rub
-Mild fever
-Tachycardia
-Labs (increased WBC and SED rate, slight increase in cardiac enzymes)
What are some s/s of right sided heart failure?
-JVD, ascites
-Peripheral edema
-Nausea and anorexia
Preload: affected by volume
Afterload: BP and valve compliance (stiff valves)
Contractility: ability of myocardium to contract (influences myocardial oxygen consumption)
What is a normal range for MAP's?
70-90
(<60 is hypoperfusion=not supplying O2, <40 is circulatory collapse)
Cardioactive medications.
Afterload:
(increase) examples of vasocontrictors
(decrease) examples of vasodilatorsVasconstrictors: norepinephrine, vasopressin
Vasodilators: morphine, nitrogylcerin, nicardipine, ACE/ARB/ARNI, hydralazine
What is the medical management for the AMI complication of pericarditis?
-Tylenol for fever
-NSAIDS for inflammation, steroids if needed
-Treat underlying cause
What is the difference between systolic and diastolic heart failure?
-Systolic= disease of pumping
-Diastolic= disease of filling
-Pulses, HR, BP, mentation, skin, breath sounds, neck veins
-BNP, ABG's, BMP, LFT's, lactate
What are some nursing interventions for caring for arterial lines?
-Maintain dressings and lines (per policy)
-Immobilize (padded splint to immobilize in neutral position)
-Assess distal extremity for neurovascular changes
-Assess for complications (thrombus, infection, nerve injury)
-Flush lines for patency
Cardioactive medications.
Preload:
increase examples.decrease examples.
Increase: volume
Decrease: diuretics, venodilators (morphine, nitroglycerin, ACE/ARB)
What is the surgical management for pericarditis?
-Pericardiocentesis (needle aspiration)
-Pericardial window (removal of small rectangle of the pericardium)
-Pericardiectomy (typically requires a sternotomy-extreme surgery, chronic pericarditis, open heart patient)
What test shows the value of ejection fraction?
What is a normal value?
What test does the patient need to be NPO for? (TEE or TTE)
-Echocardiogram
-60-65%
-TEE
What are some invasive assessments for hemodynamics? (specialty units)
-Measure pressures, flow and oxygenate in CV system
-Pressure in vessel is converted to electrical waveform
What 2 lines are NOT used for Central venous pressure monitoring?
-PICC lines
-Ports
Cardioactive medications.
Contractility:
increase examples.
decrease examples.
Increase: Inotropes (digoxin, dobumatine, milrinone)
Decrease: calcium channel blockers, beta blockers
Name some structural defects from AMI complications.
-Necrotic muscle
-Ventricular aneurysm-Myocardial rupture
-Papillary muscle rupture (not very common)
-Education:
M: Meds
A: activity/rest balance
W: weights
D: diet (low sodium/fluid)
S: symptoms (when to call)
-Meds:
Beta blockers (decrease O2 demand and workload, decrease HR and BP)
ACE/ARB (vasodilation, decrease O2 demand and workload, decreased remodeling)
ARNI (entresto= valsartan/sacubitril)
Diuretics
Aldosterone antagonist (spironolactone)
Inotropes (digoxin)
What are the perks to arterial pressure monitoring?
-direct continuous monitoring of systolic, diastolic and mean arterial pressure
-easy access for arterial blood samples (including ABG's)
A balloon tip that enters through the right ventricle and into pulmonary artery.
Swan-Ganz catheter
-Patient will not experience angina pain.
-No nerve connection to feel angina pain.