Labs, Diagnostics, Hemodynamics
What 3 things influence stroke volume
preload, after load, contractility
plaque buildup breaks off or a true blood clot occludes one or more coronary arteries
What rhythm(s) are associated with sudden cardiac death?
VT and VF
what are inotropes and give 2 examples?
digoxin, dobutamine, milrinone, dopamine, epi
SA node
What is MAP and what is normal range?
Indicates how well the organs are getting perfused, normal 70-100, but we need at least 65 to ensure brain perfusion
What changes in an EKG would indicate an MI?
ST elevation- 2 continuous leads
T wave inversion
New onset of BBB, sinus Brady, AV heart blocks, ventricular ectopy
What is the systolic and diastolic level of hypertensive crisis (urgency or emergency)
systolic: >180
diastolic: >120
beta blocker
low heart rate
What rhythms is cardio version used for and when do you deliver the shock
a fib, a flutter, SVT
r wave
A pt presents with a CVP of 9. What does this indicate about the patient and what is the normal range for CVP?
The patient is fluid volume overload.
normal range 2-6 mmHg
List and describe the two types of MI
STEMI- ST elevation, artery is occluded, needs immediate intervention (within 90 minutes)
NONSTEMI- no ST elevation, artery partially occluded, treat interventions and evaluate if intervention is needed (within 12-48 hours)
A pt has an aortic aneurysm of 5.23cm. What intervention (if any) is needed?
CT every 6-12 months and other conservative treatment- encourage smoking cessation, exercise, lower cholesterol
What is the purpose of a calcium channel blocker, what is it contraindicated in, and give at least one example.
vasodilation and decrease workload on the heart
right sided heart failure
nicardipine and diltiazem
Is defibrillation an appropriate intervention for asystole? why or why not
No, there is no conduction happening so there is no rhythm to shock and correct. Must do CPR and drugs first.
C-reactive protein- inflammation
BNP- associated with heart failure
troponin- heart damage
A pt presents to the ED in a rural community with an acute MI. EKG reveals ST elevation. What do you do?
Give thrombolytic within 90 minutes
Prepare for PTCA but they cannot go to the Cath lab for 6-8 hours if they were given thrombolytic
muffled heart sounds, narrow pulse pressure, elevated filling pressures, JVD, pulses paradoxes, tachycardia, tachypnea
Explain the rationale of using an anticoagulant post PTCA
we don't want to clog the stent with clots
A pt comes into the clinic for a procedure related to a dysrhythmia. Their medication history shows they take diltiazem and warfarin. What rhythm are they being treated for?
A fib
If coronary arteries on the RIGHT side are occluded, what monitoring would you prioritize and why?
EKG because the SA node is on the right side of the heart so dysrhythmias would be likely to occur
What are the four interventions we do for MI and what is the priority order?
morphine, oxygen, nitrates, aspirin
priority order: oxygen, aspirin, nitro, morphine
What is the nurse's priority when treating a pt with acute pericarditis
Pain and anxiety
Nitroprusside, levophed, hydralazine
levophed is norepinephrine which is a vasopressor and would only increase blood pressure even more
your patient goes into sudden ventricular tachycardia. The nurse brings you epinephrine and a defibrillator. What do you do?
shock the patient first using the defibrillator then push the epi