A&P
Describe the pathophysiology behind changes in an EKG presentation for a STEMI vs. non STEMI.
ST elevation will develop with a STEMI related to ongoing ischemia, and lack of perfusion and depth of injury. The period between depolarization and repolarization of the left ventricle is interrupted causing ST segment elevation (cells do not fully repolarize due to lack of perfusion).
ST elevation will not be present in non-STEMI due to decreased/limited depth of injury and some degree of perfusion reaching cardiac tissue.
What type of hemodynamic monitoring allows for monitoring right ventricular function, pulmonary vascular status, and left ventricular function, often times during cardiac surgery, sepsis, or valvular disease.
PAP monitoring system (Swan Ganz)
This medication can be used to treat PSVT as it slows conduction trough the AV node
Adenosine
What effect could left-sided heart failure with systolic dysfunction affect the blood pressure and HR?
lower BP, higher HR
(80-90s/40s)
Name 3 non-modifiable risk factors for atherosclerosis
age: <65
Heredity
Race: increased in African American, Mexican American, Native American
Gender: Men>Women
In a third-degree heart block the atria and the ventricles are not communicating causing variable and slowed rates and poor perfusion. A pacemaker would stimulate normal physiologic cardiac depolarization and conduction (for atria, ventricles or both) which would improve rates and perfusion.
List 3 safety precautions that nurses must take when caring for patients with central lines to prevent infection.
1) Wearing sterile gloves and mask when changing dressings and caps
2) Catheter site dressing changes when soiled or every 7 days
3)Catheter securement device
4) Staff training and education
5) Hand hygiene
Symptoms of this cardiac disorder often include malaise, fever, CP made worse with breathing, and dyspnea. It is often accompanied by a friction rub.
Pericarditis
Briefly describe one type of cardiomyopathies:
1) Hypertrophic- stiffening of left ventricle, becomes noncompliant and hypertrophic (enlarged)
2)Dilated- Gross dilation of ventricles without muscle hypertrophy (permanent remodeling)
3)Restrictive-preserved systolic function with changes to diastolic dysfunction, increased JVD, S3 S4
List two classes of medications that may be prescribed following a myocardial infarction (not including fibrinolytics or platelet inhibitors) and their action:
Vasodilators(nitrates): decrease pre load and afterload/vasodilation
Calcium channel blockers (cardizem, verapamil): if BB not effective, decreased automaticity of SA and AV Nodes, slows conduction, peripheral vasodilation, anti-ischemic)
Beta blocker (metoprolol, atenolol): Interferes with sympathetic nervous system stimulation, decreases HR, decrease contractility and cardiac oxygen need.
ACE inhibitor (enalapril, benazapril): blocks conversion of angiotensin I to angiotenson II, vasoconstrictor
Explain the pathophysiological process of endocarditis.
-Presence of nonbacterial thrombotic lesion on cardiac valve
-Bacteria or fungi attaches itself to the lesion and grows on or within the lesion
Describe the medication and indication of each medication listed in the MONA acronym that would be administered during an STEMI or non STEMI.
Morphine : Manage pain, anxiety, vasodilator (monitor blood pressure, resp status)
Oxygen: Balance demand for myocardial oxygen demand (only admin to maintain spo2 90 or greater)
Nitrates: Vasodilate (monitor BP, headache)
Aspirin: antiplatelet properties (non enteric coated)
Postoperative management and education of a patient following percutaneous coronary interventions including angioplasty and/or stenting (list 3 points).
1) Bedrest with flat HOB
2) Monitor for bleeding
3) Administration of antiplatelet medication
4) Instruct patient to keep leg extended straight that was used as access for intervention
5) Monitor renal function related to contrast (administration of fluids)
6)Withhold nephrotoxic medications
7)Monitor for s/s of recurrent angina
8) Monitor pulses distal to catheter site
Describe one medication commonly administered for Heart Failure, and one medication that is contraindicated.
Indicated: Digoxin, anticoagulants, positive inotropes, Ace inhibitors
Contraindicated: CCB (diltiazem, verapamil r/t negative inotropic effects)
An inferior wall MI is generally caused by blockage of this artery ____________ and affects conduction in AV node causing this type of conduction disturbances _______.
Right Coronary Artery
Heart blocks
What are the 3 regulators of stroke volume and explain them.
Preload: amount of stretch placed on a cardiac muscle just before systole
Afterload: the force of pressure against which a cardiac chamber must eject blood during systole
Contractility: Inotropic capabilities and cardiac workload
List three patient complications that the nurse must monitor for when the patient has lines in place for invasive hemodynamic monitoring.
1) Infection
2) Hemodynamics (HR, BP, fluid status, s/s of decreased CO)
3) EKG dysrhythmias
4) Respiratory status complications
5) Compromised circulation distal to insertion site
This EKG rhythm is the result of failure of the SA and AV note, begins in the ventricles, and is non-sustainable and a naturally protective mechanism.
This cardiac condition caused by streptococci, staphylococci, enterococci or additional bacterial/fungal elements may lead to heart failure and complications including pulmonary emboli, additional embolic complications, drug resistance, and multisystem organ failure.
Endocarditis
You are caring for a patient who is now in a complete/3rd degree heart block following a STEMI. What would be your first two nursing interventions?
1) Review ABC's
2) Prepare for external pacing (retrieve crash cart)
3) IV access
Describe two methods of treatment for hyperkalemia.
IV insulin to drive potassium from serum into cells (with dextrose to support blood glucose)
Kayexalate
Dialysis
When performing an electrical cardioversion it is imperative to have the defibrillator in this mode.
synchronized
This medication is a Class III antiarrhythmic medication. It may be used to treat atrial fib, and atrial flutter and is part of the ACLS protocol as first-line antiarrhythmic to treat pulseless vtach and pulseless vfib.
Amiodarone
300 mg bolus followed by 150 mg
Name the three types/methods of pacing that may be used including defining the method used in emergent situations.
Transcutaneous (emergent situations)
Epicardial
Transvenous (endocardial)
Explain 2 of the 3 classifications of angina
1. stable: with physical exertion or emotion stress, relieved by rest or Nitro
2. Unstable: at rest
3. Variant (Prinzmetal's): between midnight and 8 am, results from coronary artery spasm