NUR 411 Exam 1 B
Cardio Guidelines for pt with CP/possible MI - answer- EKG (initially & Q10 min while pt
has CP)
- ASA immediately (325 mg; only hold if pt pos they had one already)
- Cardiac Enzymes (initially then Q6H for 24H)
- O2 (always give)
- NTG (give if CP remains; 3 doses Q5mins)
- Morphine (only after NTG used/maxed & pain still present)
- Admit to CVICU (continuous telemetry)
- BetaBlocker Therapy (metroprolol/Lopressor)
- Anticoag therapy (Heparin)
Contraindications for Thrombolytic Therapy - answer Absolute:
- active internal bleed
- Possible aortic dissection
- Intracranial neoplasm or previous stroke
- Recent TBI
Relative:
- Severe HTN
- Dementia/intracranial pathologies
- Preg
- Recent internal hemorrhage
- recent Surgery/prolonged CPR
- Anticoag use
- Previous reaction to thrombolytics
Vasoconstrictor Meds - answer- levafed/norepinephrine
- vasopressin/Vasopress
- epinephrine
Vasodilator meds - answer- nitroprecide/Nitropress
- nitroglycerin (NTG)
Contractility meds - answer- dopamine
- dobutamine
Conditions that Increase O2 Consumption - answerHyperventilation
Hyperthermia
Hyperthyroidism
Trauma
Sepsis
Anxiety/stress
, Increased muscle activity
Conditions that Decrease O2 Consumption - answerHypoventilation
Hypothermia
Hypothyroidism
Sedation
Neuromuscular blocking agents
Anesthesia
Inactivity
Minimally Invasive Hemodynamic Technology - answer*DONT involve Heart or
Pulmonary Artery*
- CVC
- Arterial Line
2 reasons for Arterial Line - answermore effective way to continuously monitor BP
- Hemodynamic instability
- Resp. Insufficiency
Advantages to Arterial Line - answer- min to min monitoring of BP
- increase accuracy in BP monitoring
- Obtaining frequent ABGs
Disadvantages to Arterial Line - answer- Peripheral artery BP may not clearly indicate
central BP
- Occlusion of vessel --> ischemia & possible necrosis of distal tissues to insertion site
What is blood volume affected by? - answer- CO
- Venous return to heart
- Total blood volume
what does CVP reflect? - answer- measured by CVC;
- reflects venous return to heart, R. Heart Preload & R. atrial pressure (RAP)
High CVP Sx (5) - answerMimic FVE
- JVD
- increased UOP
- Crackles/sx of fluid in lungs
- > 3 sec cap refill
- BP may go up a bit
Complications of CVCs (3) - answer- Pneumothroax
- Hematoma
- Infection
Pulmonary Artery Catheters (PACs) measures (5) - answer- measures CO
Cardio Guidelines for pt with CP/possible MI - answer- EKG (initially & Q10 min while pt
has CP)
- ASA immediately (325 mg; only hold if pt pos they had one already)
- Cardiac Enzymes (initially then Q6H for 24H)
- O2 (always give)
- NTG (give if CP remains; 3 doses Q5mins)
- Morphine (only after NTG used/maxed & pain still present)
- Admit to CVICU (continuous telemetry)
- BetaBlocker Therapy (metroprolol/Lopressor)
- Anticoag therapy (Heparin)
Contraindications for Thrombolytic Therapy - answer Absolute:
- active internal bleed
- Possible aortic dissection
- Intracranial neoplasm or previous stroke
- Recent TBI
Relative:
- Severe HTN
- Dementia/intracranial pathologies
- Preg
- Recent internal hemorrhage
- recent Surgery/prolonged CPR
- Anticoag use
- Previous reaction to thrombolytics
Vasoconstrictor Meds - answer- levafed/norepinephrine
- vasopressin/Vasopress
- epinephrine
Vasodilator meds - answer- nitroprecide/Nitropress
- nitroglycerin (NTG)
Contractility meds - answer- dopamine
- dobutamine
Conditions that Increase O2 Consumption - answerHyperventilation
Hyperthermia
Hyperthyroidism
Trauma
Sepsis
Anxiety/stress
, Increased muscle activity
Conditions that Decrease O2 Consumption - answerHypoventilation
Hypothermia
Hypothyroidism
Sedation
Neuromuscular blocking agents
Anesthesia
Inactivity
Minimally Invasive Hemodynamic Technology - answer*DONT involve Heart or
Pulmonary Artery*
- CVC
- Arterial Line
2 reasons for Arterial Line - answermore effective way to continuously monitor BP
- Hemodynamic instability
- Resp. Insufficiency
Advantages to Arterial Line - answer- min to min monitoring of BP
- increase accuracy in BP monitoring
- Obtaining frequent ABGs
Disadvantages to Arterial Line - answer- Peripheral artery BP may not clearly indicate
central BP
- Occlusion of vessel --> ischemia & possible necrosis of distal tissues to insertion site
What is blood volume affected by? - answer- CO
- Venous return to heart
- Total blood volume
what does CVP reflect? - answer- measured by CVC;
- reflects venous return to heart, R. Heart Preload & R. atrial pressure (RAP)
High CVP Sx (5) - answerMimic FVE
- JVD
- increased UOP
- Crackles/sx of fluid in lungs
- > 3 sec cap refill
- BP may go up a bit
Complications of CVCs (3) - answer- Pneumothroax
- Hematoma
- Infection
Pulmonary Artery Catheters (PACs) measures (5) - answer- measures CO
