QUESTION
Fatty streaks (atherosclerotic lesions)
Answer:
Yellow & smooth; composed of lipids and elongated smooth muscle cells; do not cause
symptoms
QUESTION
Fibrous plaques (atherosclerotic lesions)
Answer:
White to white-yellow; composed of smooth muscle cells, collagen fibers, plasma, and lipids;
found in main arteries and are progressive
QUESTION
Atherosclerosis prevention
Answer:<\/li>\n\n\n\n
absorption inhibitors (ezetimibe), Niacin<\/li>\n\n\n\n
QUESTION
Atherosclerosis, nursing mgt
Answer:<\/li>\n\n\n\n
QUESTION
Acute coronary syndrome (ACS) pathophysiology
Answer:<\/li>\n\n\n\n
ischemia\/necrosis of myocardium
QUESTION
Descriptions to identify an MI
Answer:
1.the type (NSTEMI, STEMI)
2.Location of injury to ventricular wall (anterior, inferior, posterior, or lateral)
3.Point in time within process of infarction (acute, evolving, or old)
QUESTION
ACS pharm mgt
Answer:<\/li>\n\n\n\n
ACE-inhibitor, statin<\/li>\n\n\n\n
-Secondary prevention of STEMI (Ace, BB, antiCoag)
QUESTION
ACS nursing mgt
Answer:<\/li>\n\n\n\n
QUESTION
Suspected MI
Answer:
MONA (morphine, oxygen, nitro, aspirin)
QUESTION
Patient with STEMI
Answer:
taken directly to cath lab for immediate PCI
QUESTION
Thrombolytics\/Fibrinolytics
Answer:
-agents that dissolve blood clots<\/li>\n\n\n\n
Powered by https:\/\/learnexams.com\/search\/study?query=<\/a><\/li>\n<\/ul>\n\n\n\n
Cardiomyopathy diagnostic tests<\/a><\/p>\n\n\n\n Chest x-ray (cardiomegaly) Cardiomyopathy pharmacological mgt<\/a><\/p>\n\n\n\n beta blockers; potassium channel blockers, angiotensin-converting enzyme (ACE) inhibitors; digoxin, diuretics, and dysrhythmic agents.<\/a><\/p>\n\n\n\n Aortic or mitral valve d\u00e9bridement, excision, or replacement is required in what kind of patients?<\/a><\/p>\n\n\n\n – Develop congestive heart failure despite adequate medical treatment Endocarditis primary symptoms<\/a><\/p>\n\n\n\n fever & heart murmur Endocarditis medical mgt<\/a><\/p>\n\n\n\n – NSAIDs as antipyretics Endocarditis Pathophysiology<\/a><\/p>\n\n\n\n – Deformity or injury leads to clot formation Meds for Myocarditis<\/a><\/p>\n\n\n\n Penicillins, Amphotericin B<\/a><\/p>\n\n\n\n Myocarditis pathology<\/a><\/p>\n\n\n\n Viral infections or immune related (rheumatic fever, Crohn’s, Lupus)<\/a><\/p>\n\n\n\n Pericarditis – nursing mgt<\/a><\/p>\n\n\n\n Analgesics, forward-leaning or sitting position to relieve pain, gradual increases in acivity<\/a><\/p>\n\n\n\n Pericarditis assessment<\/a><\/p>\n\n\n\n – Evaluate patient in various positions Pericardial effusion<\/a><\/p>\n\n\n\n abnormal accumulation of fluid b\/w pericardial linings Cardiac tamponade<\/a><\/p>\n\n\n\n – acute compression of the heart Angina pectoris pathophysiology<\/a><\/p>\n\n\n\n – Atheroslerosis Types of Angina<\/a><\/p>\n\n\n\n stable, unstable, intractable\/refractory, variant, silent ischemia<\/a><\/p>\n\n\n\n Intractable or refractory angina<\/a><\/p>\n\n\n\n severe incapacitating chest pain<\/a><\/p>\n\n\n\n Variant angina<\/a><\/p>\n\n\n\n pain at rest with reversible ST-segment elevation; thought to be caused by coronary artery vasospasm<\/a><\/p>\n\n\n\n Silent ischemia<\/a><\/p>\n\n\n\n Objective evidence of ischemia (ECG changes w\/stress test) but no pain<\/a><\/p>\n\n\n\n Angina nursing mgt<\/a><\/p>\n\n\n\n – Treat it: stop activities, semi-Fowler’s, 12-lead ECG, nitro, oxygen Angina pharmacological mgt<\/a><\/p>\n\n\n\n Atherosclerosis pathology<\/a><\/p>\n\n\n\n – Narrowing (stenosis) of lumen, obstruction by thrombosis, aneurysm, ulceration, and rupture Fatty streaks (atherosclerotic lesions)<\/a><\/p>\n\n\n\n Yellow & smooth; composed of lipids and elongated smooth muscle cells; do not cause symptoms<\/a><\/p>\n\n\n\n Fibrous plaques (atherosclerotic lesions)<\/a><\/p>\n\n\n\n White to white-yellow; composed of smooth muscle cells, collagen fibers, plasma, and lipids; found in main arteries and are progressive<\/a><\/p>\n\n\n\n Atherosclerosis prevention<\/a><\/p>\n\n\n\n – Statins – 1st line Atherosclerosis, nursing mgt<\/a><\/p>\n\n\n\n – Elevate HOB, feet down\/dependent position Acute coronary syndrome (ACS) pathophysiology<\/a><\/p>\n\n\n\n – Plaque rupture in MI with resulting thrombus formation that occludes artery, leading to ischemia\/necrosis of myocardium<\/a><\/p>\n\n\n\n Descriptions to identify an MI<\/a><\/p>\n\n\n\n 1. the type (NSTEMI, STEMI) ACS pharm mgt<\/a><\/p>\n\n\n\n – Go to the hospital ACS nursing mgt<\/a><\/p>\n\n\n\n – Elevate HOB Suspected MI<\/a><\/p>\n\n\n\n MONA (morphine, oxygen, nitro, aspirin)<\/a><\/p>\n\n\n\n Patient with STEMI<\/a><\/p>\n\n\n\n taken directly to cath lab for immediate PCI<\/a><\/p>\n\n\n\n Thrombolytics\/Fibrinolytics<\/a><\/p>\n\n\n\n -agents that dissolve blood clots Cardiac rehab phases<\/a><\/p>\n\n\n\n Phase 1: Inpatient – hospital admittance, diagnosis, education<\/a><\/p>\n\n\n\n Phase 2: Outpatient – discharged, supervised exercise<\/a><\/p>\n\n\n\n Phase 3: Community – self-directed exercise<\/a><\/p>\n\n\n\n Cardiac monitoring<\/a><\/p>\n\n\n\n – Hardwire – uses 1 or 2 ECG leads only<\/p>\n\n\n\n – Telemetry – transmits radio waves from battery-operated transmitter to central bank of monitors<\/p>\n\n\n\n – Lead systems – most selected are leads II and V1<\/p>\n\n\n\n – Ambulatory ECG – for home monitoring<\/p>\n\n\n\n – Continuous monitors – aka Holter monitors, uses blue-tooth technology<\/p>\n\n\n\n – Real-time monitors – automatically transmits ECG to monitoring center<\/p>\n\n\n\n – Implantable devices: pacemakers that automatically detect dysrhythmias for up to 3 years<\/p>\n\n\n\n Cardiac monitoring, nursing interventions<\/a><\/p>\n\n\n\n – Use proper skin prep to eliminate artifact (abnormal ECG pattern from other issues rather than heart) and change electrodes every 24 hours Stress test for cardiac monitoring<\/a><\/p>\n\n\n\n – Avoid eating or drinking for at least 3 hours before test Patients who may require cardiac monitoring<\/a><\/p>\n\n\n\n \u00b7 Chest pain positive deflection<\/a><\/p>\n\n\n\n When an ECG waveform moves toward the top of the paper<\/a><\/p>\n\n\n\n negative deflection<\/a><\/p>\n\n\n\n When an ECG waveform moves toward the bottom of the paper<\/a><\/p>\n\n\n\n P wave<\/a><\/p>\n\n\n\n – atrial depolarization QRS complex<\/a><\/p>\n\n\n\n – ventricular depolarization T wave<\/a><\/p>\n\n\n\n – ventricular repolarization U wave<\/a><\/p>\n\n\n\n – repolarization of the Purkinje fibers PR interval<\/a><\/p>\n\n\n\n – atrial depolarization ST segment<\/a><\/p>\n\n\n\n ventricular repolarization<\/a><\/p>\n\n\n\n QT interval<\/a><\/p>\n\n\n\n – ventricular depolarization and repolarization Torsades de pointes<\/a><\/p>\n\n\n\n – A lethal ventricular dysrhythmia TP interval<\/a><\/p>\n\n\n\n isoelectric period where line remains flat<\/a><\/p>\n\n\n\n PP interval<\/a><\/p>\n\n\n\n measured from one P wave to the next to determine atrial rate & rhythm<\/a><\/p>\n\n\n\n Determining Heart Rate from the Electrocardiogram<\/a><\/p>\n\n\n\n – Count the number of small boxes within an RR interval and divide 1,500 by that number<\/p>\n\n\n\n – Ex: there are 10 small boxes between two R waves, the heart rate is 1,500\/10, or 150 bpm; if there are 25 small boxes, the heart rate is 1,500\/25, or 60 bpm<\/p>\n\n\n\n – If the intervals are the same or if the difference between the intervals is less than 0.8 seconds throughout the strip, the rhythm is called regular<\/strong>.<\/em> If the intervals are different, the rhythm is called irregular<\/strong>.<\/em><\/p>\n\n\n\n Sinus Bradycardia<\/a><\/p>\n\n\n\n \u00b7 Ventricular and atrial rate: < 60 bpm Sinus tachycardia<\/a><\/p>\n\n\n\n \u00b7 Ventricular and atrial rate: > 100 bpm, < 120 bpm Sinus Arrhythmia<\/a><\/p>\n\n\n\n \u00b7 Ventricular and atrial rhythm: Irregular Premature Atrial Complex (PAC)<\/a><\/p>\n\n\n\n – Ventricular and atrial rhythm: Irregular due to early P waves, non-compensatory pause<\/p>\n\n\n\n – PR interval:<\/strong> The early P wave has a shorter-than-normal PR interval (but still 0.12-0.20 seconds)<\/p>\n\n\n\n – are ectopic beats that originate from the atria and are not rhythms (palpitations)<\/p>\n\n\n\n – Treatment only necessary when >6\/min, reduce caffeine, correct hypokalemia<\/p>\n\n\n\n Atrial flutter<\/a><\/p>\n\n\n\n – 250 to 400 beats\/minute Atrial fibrillation<\/a><\/p>\n\n\n\n – rate is 350-600 bpm<\/a><\/p>\n\n\n\n Watchman Device<\/a><\/p>\n\n\n\n Used when patient has a-fib but is contraindicated for anti-thrombotics<\/a><\/p>\n\n\n\n Ventricular fibrillation<\/a><\/p>\n\n\n\n Ventricular tachycardia<\/a><\/p>\n\n\n\n Treatment: cardioversion, defibrillation<\/a><\/p>\n\n\n\n Atropine<\/a><\/p>\n\n\n\n Drug of choice to treat symptomatic sinus bradycardia<\/a><\/p>\n\n\n\n Heparin-induced thrombocytopenia (HIT) (type II)<\/a><\/p>\n\n\n\n
Echocardiography
ECG
Cardiac catheterization
Endomyocardial biopsy<\/a><\/p>\n\n\n\n
– Have more than one serious systemic embolic episode
– Develop a valve obstruction
– Develop a periannular (heart valve), myocardial, or aortic abscess
– Have uncontrolled infection, persistent or recurrent infection, or fungal endocarditis
Surgical valve replacement
– Have prosthetic valve endocarditis<\/p>\n\n\n\n
Additional are petechiae, Olsner nodes, Janeway lesions, Roth spots, headache, stroke, HF, tachycardia, cardio\/splenomegaly<\/a><\/p>\n\n\n\n
– Long-term IV microbial therapy<\/a><\/p>\n\n\n\n
– Bacterial infections (Staph & Strep)
– Infection most frequently occurs from clustering vegetations
– Vegetations > 10mm = Left-sided heart endocarditis
– Pulmonary emboli = Right-sided heart endocarditis<\/a><\/p>\n\n\n\n
– presence of pericardial friction rub (hallmark sign) (creaky\/scratch, louder at exhalation)
– pt has to sit, lean forward, and hold their breath for rub to be heard<\/a><\/p>\n\n\n\n
– can accumulate and choke the heart (i.e., cardiac tamponade, impair v-filling & pumping)<\/a><\/p>\n\n\n\n
– SOB, chest tightness, dizziness
– Beck triad is hallmark (hypotension, muffled heart sounds, elevated jugular venous pressure)
– heart sounds go from distant to imperceptible<\/a><\/p>\n\n\n\n
– Associated w\/angina pain: physical exertion, exposure to cold, eating a heavy meal, or stressful situation<\/a><\/p>\n\n\n\n
– Reduce anxiety: guided imagery, music therapy, spiritual needs
– Promote care: education, symptoms, prevention<\/a><\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/wlXVV9NPJUtpeG39cj8SSA.png\")
<\/figure>\n\n\n\n
– cells die due to lack of blood flow
– vulnerable where arteries bifurcate\/branch
– males have more below-the-knee pathology<\/a><\/p>\n\n\n\n
– Others: bile acid sequestrants (cholestyramine), fibric acid inhibitors (gemfibrozil), cholesterol absorption inhibitors (ezetimibe), Niacin
– Control hypertension which makes this worse (majority require 2 or more antihypertensives)
– Eliminate nicotine<\/a><\/p>\n\n\n\n
– Walk to point of pain, rest, resume
– Warm applications for arterial flow (bath, drink, pad, water bottle, etc.)<\/a><\/p>\n\n\n\n
2. Location of injury to ventricular wall (anterior, inferior, posterior, or lateral)
3. Point in time within process of infarction (acute, evolving, or old)<\/a><\/p>\n\n\n\n
– Get 12-lead ECG rhythm within 10 min
– Obtain troponin labs
– Routine interventions: MONAH (morphine, oxygen, nitro, aspirin, heparin), beta-blocker, ACE-inhibitor, statin
– Reperfusion therapy most helpful (restores blood flow to blocked arteries)
– Fibrinolytic therapy – dissolves clots
-Secondary prevention of STEMI (Ace, BB, antiCoag)<\/a><\/p>\n\n\n\n
– Oxygen 2-4 L\/min @95%
– Auscultate heart & lungs
– 12-ECG
– Assess consciousness, urine output, skin, BP, activity tolerance
– Reduce anxiety<\/a><\/p>\n\n\n\n
– only used when primary PCI not available or transport to hospital is too long<\/a><\/p>\n\n\n\n
– Best leads: lead II and lead V1<\/a><\/p>\n\n\n\n
– Avoid chocolate or caffeine for 24 hours<\/a><\/p>\n\n\n\n
\u00b7 Palpitations
\u00b7 Acute Coronary Syndrome – STEMI, NSTEMI, unstable angina
\u00b7 Following major surgery – ITU, HDU, cardiac surgery
\u00b7 Major trauma
\u00b7 Post cardiac\/respiratory arrest
\u00b7 Acute medical conditions –
\u00b7 Pulmonary embolus, drug overdose, electrolyte imbalance
\u00b7 Unexplained syncope episodes
\u00b7 Shock
\u00b7 Undergoing a specific treatment<\/p>\n\n\n\n
– up to 0.11 seconds<\/a><\/p>\n\n\n\n
– up to 0.12 seconds<\/a><\/p>\n\n\n\n
– aka resting state<\/a><\/p>\n\n\n\n
– sometimes appears in those w\/hypokalemia, HTN, or heart disease<\/a><\/p>\n\n\n\n
– 0.12 to 0.20 seconds<\/a><\/p>\n\n\n\n
– usually 0.32 to 0.40 seconds<\/a><\/p>\n\n\n\n
– Associated with long QT interval
– Treated with magnesium<\/a><\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/6f6Pl.7l24Kvq8Gda4kAAQ.png\")
<\/figure>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/mn2Up4zqJnoRoQu7kgtEWg.png\")
<\/figure>\n\n\n\n
– Tx: Atropine
*intervals are spaced out<\/a><\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/vSjZS5mz8XzeFy5lqR4X.g.png\")
<\/figure>\n\n\n\n
*intervals are shortened
– Treat with beta-blockers
– If wide QRS: CCB, adenosine, procainamide, amiodarone, sotalol
– If persistent: Catheter ablation<\/a><\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/Y2UqbjjCnOJUYIZkyooelA.png\")
<\/figure>\n\n\n\n
– creates an impulse at an irregular rhythm; the rate usually increases with inspiration and decreases with expiration
*not typically treated<\/a><\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/XjPe.kPPbcwh9kRhxGcseQ.png\")
<\/figure>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/OUhXJc-ANsVtpKdTKhfRFA.png\")
<\/figure>\n\n\n\n
– abnormal rhythm from atria
– saw tooth P configuration
– Tx: IV adenosine<\/a><\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/B8LLM5GNMY6dGeMnShJf2g.png\")
<\/figure>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/9kvoAGQxTsgDP73stPAvuA.png\")
<\/figure>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/1LdpENf5AY9OCm.5Wp.W-A.png\")
<\/figure>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/xIJjCDp4A-9zuCYsf7MNyg.png\")
<\/figure>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/6VB9vrbblwTlu-DSLp-JyQ.png\")
<\/figure>\n\n\n\n