ACS and MI!
symptoms?
acute chest pain, radiating pain, n/v, fatigue, insomnia, confusion, weakness, sob
what are two percutaneous coronary interventions (PCI)?
percutaneous transluminal coronary angioplasty (PTCA) aka balloon angioplasty, coronary artery stent
what even is heart failure?
occurs when the muscle of the heart is unable to pump enough blood to adequately meet the body's needs
DUH, stoopid
viscera and peripheral congestion, jvd, dependent edema, hepatomegaly, ascites, and weight gain are clinical manifestations of what type of hf?
what is right sided hf or cor pulmonale
how do you improve circulation in for arteries and veins?
position feet down for arteries and up for veins
nurse bennett is taking care of nurse lenore, who seems to have had a STEMI during her shift. dr clemson gives these orders to help treat lenore's symptoms
ecg monitoring, morphine iv, O2, NTG, aspirin
followed by PCI (balloon angioplasty within 60 mins) (thrombolytics if PCI is not available), may include stenting, rehab after stabilization
what is a coronary artery bypass graft
vein bypass
how do you diagnose hf?
a thorough hx and assessment, chest xr, echocardiogram, ecg and/or labs such as cardiac enzymes, CBC, urinalysis, lfts, serum electrolytes, fasting lipid profile, BNP (confirms absence, presence, and/or severity of pts heart failure)
in this heart failure, you can have pulmonary congestion, DOE, weigh gain, and JVD (all symptoms of hf)
what is congestive hf
what are the oh me, oh my's for PAD?
(really, what does oh me, oh my mean?)
critical limb occlusion (plaque buildup)... 6p's- pain, parasthesia, pallor, paralysis, poikilothermia (coldness), pulseless
acute limb occlusion (emboli)... sudden, severe pain with changes in the 6ps
nursing interventions
relieve pain and s/s of ischemia, improve resp function, promote adequate tissue perfusion, reduce anxiety, monitor and manage potential complications, education, continuity of care via home health or cardiac rehab
lenore has received a coronary artery stent for a 90% blockage of her coronary artery following her STEMI. what lifelong tx is required?
antiplatelet therapy- usually aspirin or clopidogrel
tx
this heart failure presents with pulmonary congestion with crackles heard in the lungs, S3 aka vent gallop, DOE, low O2 sat, dry nonproductive cough (initially) and oliguria
what is left sided hf
which patient is at highest risk for venous thromboembolism?
a) 50yo post op pt
b) 25yo pt with a central venous cath in place to treat septicemia
c) 71 yo otherwise healthy adult
d) 30yo pregnant woman due in 2 weeks
b
Rationale: Some risk factors for venous thromboembolism include but are not limited to age older
than 65 years, patients undergoing surgery, central venous catheter placement, septicemia, and
pregnancy. The client in this question with two risk factors is the 25-year-old with a central venous
catheter in place to treat septicemia. All other patients only have one risk factor.
what is the difference between unstable angina, STEMI, and NSTEMI
unstable- clinical manifestations but ECG and cardiac biomarkers show no evidence of acute mi
stemi- ECG and characteristic changes in two contiguous leads on a 12 lead ECG...SIGNIFICANT DAMAGE TO MYOCARDIUM
nstemi- elevated cardiac biomarkers but no definite ECG evidence of acute mi...MAY BE LESS DAMAGE TO MYOCARDIUM
complications of PCIs
pseudoaneurysms, embolism, allergic reaction to contrast dye, dysrhythmias, bleeding, reocclusion, kidney impairment from dye
lenore is teaching nicole and bennett about heart failure. she says "oh me, oh my!" what does this mean?
(idek...)
exacerbations that could lead to fvo, pulmonary edema that could lead to orthopnea, renal failure, and pump failure
what is the difference between HFrEF and HFpEF
r= reduced and the left vent does not contract, EF is <40%...aka systolic hf
p= preserved and the left vent is stiff and cannot relax to fill, EF>50%...aks diastolic hf
what happens if you reduce bp at a high rate?
risk for ischemic stroke
resp, gi, gu, skin, neuro, and psych s/s indicative of acs or mi
resp- sob, dyspnea, tachypnea, crackles if it has caused PE
gi- n/v, indigestion
gu- decreased uop can indicate cardiogenic shock
skin- cool, clammy, diaphoretic, pale appearance d/t sympathetic stimulation can indicate cardiogenic shock
neuro- anxiety, restlessness, lightheadedness
psychological- fear with feeling of impending doom; denial
nursing priority for ptca with or without stents
monitor site for bleeding/hematoma formation. if either occur, hold direct pressure and have someone call the provider
bleeding precautions with anticoags
what are the weight, fluid, and sodium restrictions for someone with hf?
2lbs in a day or 5lbs in a week, 64 fl oz, and 2000 mg
what are some ways to diagnose/visualize atherosclerosis?
abi- ankle brachial index to check bp...anything less that 0.90 is abnormal
exercise testing
duplex- ultrasound of legs or neck that can show plaque
CT- check for iodine or shellfish allergy
angiography
mri
hypertensive emergency vs urgency...what are the differences?
emergency is actively posing an attack on target organs such as the kidneys, eyes, and the brain