Heart Failure
What does it mean to have Diastolic Heart Failure?
Dysfunction with the relaxation and filling of the heart
Name the IV Anticoagulant used for treatment of ACS, Afib, and DVT/PE
Heparin
BONUS 100 POINTS! If the patient is HIT+, what other anticoagulant can be used?
What needs to be in every Dr. Foy patient's room?
The "Dr. Foy" Walk sheet
What is a task the RN can delegate to the PCT in preparation of your patient going to cath lab?
Surgical clipping the groin and/or wrist
BONUS 100 POINTS! - Where does the PCT or RN need to clip hair?
Explain where you place the 6 leads on your patient.
White = under right clavicle, close to shoulder
Green = lower, right aspect of ABD
Black = under left clavicle, close to shoulder
Red = lower, right aspect of ABD
Brown/Brown = 4th intercostal space on right side of sternum
Brown/White = 5th intercostal space on left side of sternum
What does Ejection Fraction mean?
The amount of blood pumped out of the heart to perfuse the body
What lab value are you looking at prior to administering a diuretic to your patient?
Creatinine
BONUS 200 POINTS! - What other cardiac medications can cause a negative effect on the kidneys?
When should the first walk of the day be for your CABG patient?
What medications should be held and given prior to cath lab?
Hold - diuretics, oral hypoglycemics, potassium supplements, ACE/ARB, anticoagulants (heparin can be turned off in cath lab)
Give - other BP meds, beta blockers, aspirin, antiplatelet medications
Explain where to place leads for a 12 lead EKG.
V1 = 4th intercostal space right side of sternum
V2 = 4th intercoastal space left side of sternum
V3 = angled between V2 & V4
V4 = Fifth intercoastal space space, left midclavicular
V5 = horizontal plan between V4 & V6
V6 = horizontal plan left midaxillary
RA = right shoulder/wrist
RL = right thigh, above knee/ankle
LA = left shoulder/wrist
LL = left thigh, above knee/ankle
Name the two most common IV diuretics seen on the unit?
Bumex and Lasix
100 POINT BONUS! - if you can also name the IV diuretic "booster" used
What two medications are class III antiarrhythmics and must be admitted to our unit when starting the med and being "loaded"?
Tikosyn and Sotalol
BONUS 100 POINTS! - What part of the 12-lead EKG are you trending with serial EKGs 2 hours after administering the medication?
What post op day can the patient shower?
POD#5 as long as the patient has all chest tubes and pacerwires out
Your patient has sign/held orders for cath. When do you release them?
ASAP. Can retime labs, IVF, NPO, etc if needed.
use suction tubing to link the port on the atrium directly to the suction regulator.
DO NOT USE SUCTION CANISTER
Describe the RAAS system
Renin-angiotensin-aldosterone system (RAAS) chain reaction that regulates blood volume and systemic vascular resistance through sodium and water reabsorption, K secretion, and vascular tone.
Renin = hormone by kidneys, converts angiotensinogen into angiotensin 1; stimulated when BP drops, Na drops, HR drops
Angiotensin = hormone causing vasoconstriction and stimulates adrenals to secrete aldosterone
Aldosterone = tells kidneys to retain water and salt & increases blood pressure
Your heart failure patient is on a dobutamine (positive inotrope) drip to help increase cardiac output and perfusion. What lethal dysrhythmia would you want to watch for on tele?
VTach
BONUS 200 POINTS! - What medication should you always question if ordered for your patient on Dobutamine?
What is the oxygen level your patient would need to be below to warrant administering oxygen per Dr. Foy?
Below 88%
BONUS 100 POINTS! - What interventions should you encourage your patient to do if they are desaturating?
How far in advance can you prep your patient for cath?
Consent = anytime. good until procedure is done unless rescinded
Clipping = up to 24 hours before
Metformin
What is the newer "magic" heart failure medication?
BONUS 200 POINTS! How does it work?
Entresto, sacubitril/valsartan
Valsartan = angiotensin receptor blocker, disrupts RAAS system
sacubitril = neprilysin inhibitor, which prevents the breakdown of peptides and bradykinin (which help to remove sodium and relax blood vessels)
Name the medications a patient who had a MI should be on prior to discharge unless contraindiciated.
Aspirin, antiplatelet, statin, beta-blocker, and ACEi or ARB.
List 5 standards of care for Dr. Foy's patients.
- 4 walks a day (Physical therapy does not count)
- blinds open during the day
- SCDs and TEDs during the day, TEDs off at night, washed in sink and hung to dry
- daily weight
- walked and up in chair by 7am
-IS 10x/hr
- Dr. Foy walk sheet completed before 7am
- paint all incisions with betadine BID until showering
- Bactroban to nares x5 days
- pain control
- up in chair for all meals
When performing an Activated Clotting Time (ACT) test to determine if you are able to pull your patient's sheath, what is the value needed for you to be able to pull the sheath?
<180
Explain the different between a NG tube and Dobhoff tube
-NG Tube = larger French tube, used to decompress stomach. Can be used for tube feedings if needed.
- Dobhoff = smaller French, used for tube feedings only. CANNOT USE W/ SUCTION TO DECOMPRESS STOMACH.
BONUS 200 POINTS! - when inserted, what special trick must you do to remove the guidewire on a Dobhoff tube?