MedSurg 3 Final Exam Review

MedSurg 3 Final Exam ReviewCardiac (24) MAP: > 65 for adequate blood flow to major organs (MAP= 2x diastolic + Systolic/3) Preload: Amount of blood into heart at end of diastole Afterload: Resistance met when blood pushes out of left ventricle SA Node: located in right atrium, natural pacemaker of the heart (60-100bpm) AV Node: delay impulse to allow atrial contraction and ventricle filling, then conducts impulse to the ventricles (40-60bpm) Purkinje Fibers: ventricular pacemaker (20-40bpm) Labs: PT (9-12) INR (0.9-1.2) PTT (55-75) ABG (pH: 7.35-7.45, CO₂: 45-35, HCO₃: 22-26) CBC (blood) BMP (electrolytes) Diagnostic Tests: CXR, EKG, Stress test, Echo, TEE, MRI Heart Cath: Pre- consent, prep area, NPO 6hrs, mark pulses, BUN/Cr, Fluids and mucomyst to facilitate excretion/protection; Hold GLUCOPHAGE 24-48 hrs pre/post; ALLERGY: shellfish/dye Post- BEDREST, vitals, monitor site/pulse, ↑fluids (↓dye), Pain, Hematoma, ↓Vitals, color, arrhythmia, Retroperitoneal Bleed Nursing- no lifting > 5lbs., remove dressing in shower, don’t resume normal activities until Dr. release, medication education Hemodynamic Monitoring: Measures vascular capacity, blood volume, pump effectiveness, tissue perfusion Risks: thrombosis, hematoma, bleeding, pneumothorax, dysrhythmias, pericardial tamponade A-Lines: into artery, DO NOT PUSH MEDS, monitor BP and ABG Central Lines: give meds, draw blood, monitor CVP (Dry 2 ←→6 Wet) CABG Unstable angina, AMI, failure of percutaneous interventions Pre- CBC, CXR, Coags, UA, coronary angiogram, blood type, teaching Post- ↓CO (bleeding, fluid loss, meds, ↓temp, surgery, dysrhythmias, ↑afterload) *chest tube drainage: >70mL = report *cardiac tamponade: muffled heart sounds, ↑HR, ↓BP, ↓urine, ↓chest tube output, ↓peripheral pulses, tx- pericardiocentesis, cause Heart Failure Causes: HTN, CAD, substance abuse, valvular disease, DM, smoking, lung disease, MI Dx: ↑BNP (untreated) Tx: diuretics, ACE, ARB, nitrates, Beta blockers, inotropic agents, diet, fluid management, weight Complications: pulmonary edema (dyspnea, cyanosis, gurgles, pink/frothy sputum, ↓O₂), shock Nursing: weight, diet, meds, activity, risks *Digoxin Toxicity: anorexia, fatigue, blurred vision, mental status change Myocardial Infarction Blood supply to the heart is reduced or stopped; “TIME IS MUSCLE”