CAD & ACS
Inherited predisposition to develop new blood vessels.
What is angiogenesis?
List two things about BNP.
•BNP ( B-type Natriuretic Peptide)
•A simple test that helps diagnose patients with CHF
•↑ levels by heart tissue when overloaded with pressure & excess volume
•↑ BNP is highly sensitive and specific for the diagnosis of HF
•Also useful for differentiating pulmonary and cardiac causes of dyspnea
What are the shockable rhythms?
Vfib. and Pulseless Vtach
pH: 7.35-7.45
PaCO2: 35-45
HCO3: 22-26
PaO2: 80-100
What is the difference between hypoxemic and hypercapnic respiratory failure?
Hypoxemic respiratory failure (oxygenation failure)
• PaO2 < 60 mm Hg with either normal or slightly
subnormal PaCO2 levels
• Inadequate exchange of O2 between the alveoli and pulmonary capillaries
Hypercapnic respiratory failure (ventilator failure)
• PaCO2 > 50 mm Hg and may be accompanied by hypoxemia and/or acidemia
• Insufficient CO2 removal
Name and describe the 3 developmental stages of atherosclerosis.
Fatty Streak: lipid accumulation into smooth muscle cells, yellow tinged
Fibrous Plaque: collagen covers the fatty streak, vessel lumen narrowed, blood flow reduced, fissures develop; grey/whitish
Complicated Lesion: continued inflammation can result in plaque instability, ulceration, and rupture
Explain the difference between HFrEF and HFpEF.
Systolic/HFrEF - Inability to of the ventricles to eject properly. Will see decrease in EF (<45%). Blood backs up into left atrium & lungs, causing pulmonary edema.
Diastolic/HFpEF - Inability of the ventricles to relax & fill during diastole (usually due to stiffness & noncompliance). Results in decreased SV & CO. Diagnosis by s/s, normal EF, evidence of diastolic dysfunction on imaging
What are the normal ranges for the PR interval, QRS complex, and QT interval?
PR interval: 0.12-0.20
QRS complex: less than 0.12
QT interval: 0.34-0.43 or less than 0.50
Determine what the pt is experiencing with the following ABGs. pH: 7.27, PaCO2: 68, HCO3: 28, PaO2: 60
pH: 7.27 low (acidic)
PaCO2: 68 high (acidic)
HCO3: 28 high (alkalotic)
PaO2: 60 low (hypoxemia)
Partially Compensated Respiratory Acidosis with hypoxemia
Ratio of air entering lungs to alveoli to the amount of blood flowing to capillaries are not equal.
What is V/Q Mismatch?
Name five causes of endothelial injury.
1. Hypertension
2. Tobacco use
3. Hyperlipidemia
4. Diabetes
5. Infections
6. Toxins
7. Hyperhomocysteinemia
Define ventricular dilation and ventricular hypertrophy.
Ventricular Dilation: Enlargement in the chambers of the heart from the muscle fibers stretching in response to increased preload à causes temporary increased contraction & subsequent increased CO for maintenance of BP & perfusion.
Ventricular Hypertrophy: Increase in the muscle mass and heart wall thickness that occurs from overwork and strain. Initially increases contractile power of the muscle fibers which increases CO & perfusion.
Which dysrhythmia has the following characteristics?
P wave difficult to identify, R-R constant, QRS <0.10, rate: 150-250, regular rhythm.
SVT
Name 3 causes of respiratory alkalosis. Explain each cause.
Causes: Psychogenic (fear, pain, anxiety), CNS stimulation (brain injury, ETOH,
salicylate poisoning, brain tumor), Hypermetabolic states (fever, thyrotoxicosis, sepsis, pregnancy), Hypoxia (high altitude, pneumonia,
heart failure, pulmonary embolism), Mechanical ventilator rate too fast
Name three causes of alveolar hypoventilation.
- Central Nervous system (CN)S) problems
- Chest wall dysfunction
- Acute asthma
- Restrictive Lung Disease
Name five major modifiable risk factors for CAD. Explain how each are risk factors.
•High serum lipids: more available lipids to accumulate within vessels
•Hypertension: ↑ BP = endothelial injury = atherosclerosis = ↑ force = ↑ BP
•Tobacco use: releases catecholamines = ↑ HR, vasoconstriction, and ↑ BP = ↑ heart’s workload
•Physical Inactivity: Exercise = efficient lipid metabolism, ↑ HDL production, ↓ thrombus formation
•Obesity: BMI > 30 and waist circumference > 40 inches (men) and > 35 inches (women)
•Diabetes: causes endothelial injury and changes to lipid metabolism = ↑ cholesterol & ↑ triglycerides
•Metabolic Syndrome: cluster of risk factors for CAD (obesity, HTN, ↑ serum lipids, ↑ glucose)
Define preload, afterload, cardiac output, and ejection fraction.
Cardiac output=amount of blood pumped by the heart in 1 minute (norm 4-8 L/min)
Preload=amount of blood present at the end of diastole prior to the next ventricular contraction (increased by hypertension, aortic valve disease, hypervolemia)
Afterload=peripheral resistance the LV has to pump against in order to open the pulmonic/aortic valves; force opposing the movement of blood
Ejection fraction-the % of blood leaving your heart each time it contracts (norm 55-60%; measured by echocardiogram or cardiac catherization)
What are the two treatment goals for pts with A.fib?
#1 Decrease ventricular rate
• Drugs to slow HR: -adrenergic blockers, IV calcium- channel blockers
#2 Prevent embolic stroke
• Long-term anticoagulation: Coumadin, Alternative anticoagulants
Name three nursing responsibilities for pts with an ET tube in place
- Verify proper placement
- Assess for proper cuff inflation
- Continuously assess tube for placement/dislodgment/cuff leak
- Provide oral care and maintain integrity of oral mucosa every 2-4 hours and PRN
- Implement frequent position changes and perform ROM exercises
Name the four primary causes of hypercapnic respiratory failure.
1. CNS problems
2. Neuromuscular problems
3. Chest wall abnormalities
4. Problems affecting airway and/or alveoli
Name the normal ranges for the following: Total cholesterol, LDL, HDL (men and women), Fasting Triglyceride
Total Cholesterol <200 mg/dL
LDL < 130 mg/dL
HDL >40 mg/dL (men) and >50 mg/dL (women)
Fasting triglyceride < 150 mg/dL
Name two medications that increase contractility of the heart muscle and two different side effects for each.
Dobutamine: Hypertension, dysrhythmias, angina, headache
Digoxin: Dizziness, changes in mood and mental alertness (confusion, depression and lost interest), anxiety, nausea, diarrhea, headache, rash
Name two types of pts who are appropriate for an implantable cardioverter-defibrillator.
• Have survived SCD
• Have spontaneous sustained VT
• Have syncope with inducible ventricular
tachycardia/fibrillation during EPS
• Are at high risk for future life-threatening
dysrhythmias
Describe the difference between Assist-Control and Pressure-Control modes on the ventilator.
AC: A set respiratory rate, tidal volume, PEEP,
inspiratory time, & FiO2%
• Most common mode
• Considered “full” support
• Patient is capable of taking spontaneous
breaths and set volume is delivered
- Can be used for pts with or without
spontaneous breaths
- Reduces work of breathing and allows the
respiratory muscles to rest
- Risk of hyperventilation due to many
spontaneous breaths at set tidal volume.
May lead to respiratory alkalosis
- Sedation may be needed to limit
spontaneous breaths
PC: A set respiratory rate, peak inspiratory
pressure (PIP), inspiratory time, & PEEP
• Considered “full” support
• Patient can initiate spontaneous breath
and vent will deliver a volume of gas up to
the set PIP limit
- PIP is never exceeded, but tidal
volume varies
- Sedation may be needed to limit
spontaneous breaths
- Setting used for ARDS patients to
decrease risk of volutrauma or barotrauma
Name two settings on the ventilator that is preferred for pts with ARDS.
- Low tidal volume (VT) ventilation (4-8 mL/kg) – limits volutrauma and barotrauma
- Permissive hypercapnia – consequence of low tidal volume ventilation, where PaCO2 levels will slowly rise above normal range. PaCO2 up to 60mmHg is
acceptable in ARDS
- Positive end-expiratory pressure (PEEP) – helps open collapsed alveoli
• Improves oxygenation while decreasing FiO2 needs