Student Nurse Laura

Orem – "creative effort of one human being to help another human being."

Archive for the ‘Acute Cardiovascular Disease’ Category

Posted by Laura on March 28, 2011

Posted in Acute Cardiovascular Disease, NS 241 - Med/Surg II | Comments Off on

CVD Notes:

Posted by Laura on March 28, 2011

Atheroma: abnormal accumulation of lipid & fibrous tissue in intima of coronary artery walls that changes their structure and function

Major manifestation : CP due to impaired blood flow > 70% blockage

What are the various Metabolic Syndromes which will increase risk of Coronary Artery Disease?

Elevated C-Reactive Protein          > 3mg

Central Obesity                               > 35” W, 40” M

Fasting BS                                       > 100

Elevated BP                                      > 140/90

Triglycerides                                    > 150

Angina Pectoris – not completely occluded

♥     Stable Angina – Reversible, relieved by rest

♥     Unstable Angina –  Progressive, plaque ruptures, occurs at rest (Pre-infarction, Crescendo)

♣ Prinzmetal (variant or resting) Angina – Coronary Artery ‘Spasm’, occurs only at rest.

♥     Intractable (refractory) Angina – severe incapacitating chest pain

♥     Silent Ischemia – objective evidence, but asymptomatic. DM

Myocardial Infarction (MI) – Occlusion

♥     Non ‘Q’ Wave MI (nontransmural) – only myocardium

♣   T Wave Inversion Ischemia

♣   Elevated ST segment Injury

♥     Q Wave Infarct (transmural) – involves all 3 layers

 

Ischemia & Tx Differences

Unstable Angina: thrombus partially or intermittently occludes the coronary artery; CP, s/s occurs at rest with exception: limits activity > 10 min.; Bio-markers are NOT elevated. Tx: MONA, ABCS-Ph,

Non-ST Segment Elevation: thrombus partially or intermittently occludes the coronary artery; CP, s/s occurs at rest with exception: limits activity – longer in duration and more severe than in unstable angina; Bio-markers ARE elevated. Tx: MONA, ABCS-Ph, include cardiac catherization and possible PTCA

Non-ST Segment Elevation: thrombus FULLY occludes the coronary artery; CP, s/s occurs at rest with exception: limits activity – longer in duration and more severe than in unstable angina; ST segment elevation or new left bundle branch block on EKG, Bio-markers ARE elevated. Tx: MONA, ABCS-Ph,  – PTCA within 90 minutes of medical evaluation to keep vessel open; Fibrinolytic therapy within 30 minutes of medical evaluation.


TPA

Tissue plasminogen activator (alteplase) activates plasminogen to break clot.

IV bolus → infusion → IV heparin or LMWH and ASA

*relief of pain, early peak enzymes, reverses EKG changes, saves cardiac muscle.

*complications: hemorrhage, reperfusion arrhythmis – Tx: with amiodarone!

Reperfusion injury: damaged tissue from reperfusion leads to dysrhythmias.

 

Cardiogenic Shock (end stage of LV dysfunction due to extensive damage. Loss of contractility, marked reduction in CO, inadequate perfusion to vital organs) : Too much fluid volume – leads to inadequate tissue perfusion / shock syndrome: Tx: If hypervolemic=diuretics, if hypovolemia=albumin,

Norepinephrine

S/S: Weak rapid pulse

 

Pulmonary Effusion: fluid is normally only 50mL. Tx: Pericardiocentesis, pericardiotomy

Pulmonary Edema: when head is above heart (HOB ele.) you have Jugular vein distention, and blood – tinges frothy sputum. (RV is supplying more blood than LV can handle and accumulates into pulmonary beds leaking from capillaries into airways.) = Hypoxemia!

Cardiac Tamponade: falling systolic BO, narrowing Pulse Pressure, Rising venous pressure (increased JVD) muffled heart sounds.

 

 

Hypothermia

What is hypothermia good for: Neuroprotection.  Unconscious adults  w/spontaneous circulation (<1 hr) , out of hospital cardiac arrest for 12-24hrs at 32-34C when initial rhythm was V Fib. MAP > 60, Systolic BP > 90

Contraindicated: bleeding, infection, head trauma, unstable arrhythmia, downtime > 10min w/o BLS, < 18 not an adult, Pregnancy

Works if <10 to BLS  a witnessed Arrest!

 

CCP for R ventricular function and systemic fluid status.  Normal 2-6

http://www.rnceus.com/hemo/cvp.htm

Posted in Acute Cardiovascular Disease, NS 241 - Med/Surg II, Semester IV | Comments Off on CVD Notes:

Can you name it?

Posted by Laura on March 23, 2011

This ECG is abnormal – what is going on? Leave a comment

Posted in Acute Cardiovascular Disease, NS 241 - Med/Surg II, Semester IV | 1 Comment »

Heart Sounds

Posted by Laura on March 18, 2011

S1, Lub Dub

watch MV on TV

S2, Lub Dub

have some fun in AV & PV

 

S3, Ken-(tuck-y)

Too much fluid, in little old me.

 

S4, (Ten-ne)-see

The artrial gallops, and I’m as stiff as can be.

(by HTN & CAD)

Posted in Acute Cardiovascular Disease, NS 241 - Med/Surg II | Comments Off on Heart Sounds

Week 7 Reading

Posted by Laura on March 15, 2011

Week 7 Reading NS240&241 Rm114 .doc

Week 7 Reading NS240&241 Rm114 .pdf

Posted in Acute Cardiovascular Disease, NS 240 - Professional IV, NS 241 - Med/Surg II, Reading Schedule 240 241 | Comments Off on Week 7 Reading

Crackles to Tamponade

Posted by Laura on March 7, 2011

Posted in Acute Cardiovascular Disease, Concepts, Physiologically, Renal, Resources | Comments Off on Crackles to Tamponade

ECG and K+

Posted by Laura on February 19, 2011

K+

Hyperkalemia

Peaked narrow T waves, ST segment depression, Shortened QT interval

PR interval prolonged

Disappearance of P-waves

Decomposition and prolongation of QRS complex

Other S/S: Peripheral nervous system: muscular weakness, paralysis of respiratory and speech muscles. GI: nausea, colic, diarrhea. CNS: little effect

Tx – from fastest – slowest

  • IV Calcium Gluconate

o   (antagonizes adverse cardiac conduction abnormalities – only lasts a few minutes)

  • IV Glucose-Insulin-bicarb

o   (shifts K+ into cells)

  • Albuterol
  • Kayexalate
  • Hemodialysis

Posted in Acute Cardiovascular Disease, Semester IV | Comments Off on ECG and K+