NUR 339 Fianal 1 - 2. what determines preload Answer venous return...

NUR 339 Fianal 1

• Preload

Answer stretch (length) of LV myocardial fibers at end diastole

• what determines preload

Answer venous return

• Afterload

Answer resistance to ventricular ejection

• when are the coronary arteries normally perfused

Answer during diastole (rest)

• angina

Answer chest pain associated with transient myocardial ischemia

• myocardial ischemia

Answer decrease in O2 that causes pain but NOT infarction or death

• how is pain relieved with angina

Answer rest and/or vasodilators (nitroglycerin)

• stable angina pain relief 1 / 3

rest or use of NTG

• variant angina pain relief

Answer rest, during sleep, with minimal exercise or stress

• myocardial infarction

Answer loss of coronary blood flow and subsequent death of myocardial cells and tissue

• STEMI (ST Elevation Myocardial Infarction)

Answer transmural/q-wave-involves full thickness of ventricular wall, most common with obstruction of single coronary artery (most MI's are transmural and involve LV)

• non-STEMI (non-ST elevation MI)

Answer subendocardial/non-Q wave - involves inner 1/3 to 1/2 of ventricular wall - most common when arteries are severely narrowed but still patent

• patho of ischemia/MI

Answer cell changes start with minutes with irreversible cell death after 20-40 minutes

• area of necrosis

Answer tissue has died, does not conduct electrical activity or move- will be replace with scar tissue

• inflammatory response most at risk

Answer 4-7 days, center of infarcted area is soft/weak- may rupture

• remodeling inflammation response 2 / 3

lead to hypertrophy, loss of contractility, and heart failure

• atypical presentation of MI common with

Answer women and elderly

• STEMI EKG findings

Answer ST segment elevation

• necrotic cells become electrically inactive and cell membranes become disrupted

• cardiac markers

Answer enzymes and muscle proteins released from myocardial cells as they die

• troponin

Answer

• begins to rise in 2-6 hours, peak at 12-36 hours, returns to normal in 7-10 days, found only in

heart muscle

• best practice

• nitroglycerin

Answer give up to 3 sublingual tabs or spray "doses" every 3-5 minutes for ongoing symptoms

• what would you monitor while administering mitroglycerin

Answer BP (vasodilators can lower it)

• when should nitroglycerin not be given
• / 3