cardiac vascular certification ACTUAL EXAM || MOST RECENT
EXAM ACTUAL COMPLETE REAL EXAM QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) ALREADY GRADED A+ |
GUARANTEED SUCCESS!! NEWEST EXAM | JUST RELEASED!!
asprin for treatment of STEMI
81 to 325 mg PO load (Chewed!) Onset of action 1 to 7.5 min. inhibits
cyclooxygenase 1 within platelets and prevents formation of thromboxane
A2. disables platelet aggregation. Monitor for intolerance and bleeding.
used indefinitely post MI. Maintenance dose for life at least 81 mg daily.
STEMI treatment: nitroglycerin
0.4 mg SL every 5 minuter times 3. Sublingual, spray or infusion, Tridil. May
use IV if continued chest discomfort/ symptoms. potent vasodilator, monitor
for hypotension, headache. Reduces preload and ventricular wall tension.
Decreases myocardial o2 consumption. Avoid if suspected right ventricular
infarction or use of phosphodiesterase inhibitors, Viagra or Cialis.
STEMI Treatment: O2 supplemental
only if sats < 94%. hyperoxemia perpetuates oxidative injury after MI, can
worsen and increase infarct size. Not needed for patients without
evidence of respiratory distress.
,STEMI Treatment: morphine
Small incremental doses IV Q5 to 15 min if chest pain is unrelieved by NTG. use
as adjunct therapy to NTG. Potent analgesic and anxiolytic. Causes
Venodilation and reduces preload mild afterload reduction. Decreases
workload of heart. Use Cautiously in UA and NStemi, increased mortality in
large patient registry. causes hypotension. Avoid if suspected right
ventricular infarction.
post PCI therapy: access site
radial artery access site is becoming more popular: fewer complications.
Monitor for arterial vasospasm.
Femoral: monitor for bleeding, hematoma, retroperitoneal bleeding. Rare
cases, can develop pseudoaneurysms, AV fistual.
post PCI Therapy: retroperitoneal bleeding
will see soft bp that is fluid responsive, Back pain, tachycardia; may not see
if patient received beta blockers. Late sign is flank ecchymosis (grey
turner's sign) assess coags, control bleeding. monitor renal function
closely (dye load)
post PCI medication management
Aspirin, (indefinitely) P2Y12 inhibitor (usually for 1 year), beta blocker
(indefinitely), statin (high dose indefinitely), ACE Inhibitor or ARB (if EF
<40%, indefinitely)
,P2Y12 inhibitors
Clopidogrel (Plavix) 300 to 600 mg load; continue 75 mg daily for 12 months
Prasugrel (Effient) 60 mg load; continue 10 mg for 12 months
Ticagrelor (Brilinta) 180 mg load; 90 mg BID for 12 months
Other recommendations: Unfractionated Heparin or Bivalirudin, angiomax:
used during PCI; finish in cath lab; half life 25 min with normal renal function.
Dose;
0.75 mg/kg IV bolus. Then 1.75mg/kg/hr IV infusion for duration of the
procedure. May continue for 4 hours post procedure.
Other recommendations: GP IIb/IIIA inhibitors at time of PCI
Abciximab, reopro. Eptifibatide, Integrilin. Tirofiban, Aggrastat. monitor
platelet count and for bleeding.
Beta blockers: oLOL
Start within 24 hours if hemodynamically stable. Hold if hypotension or
signs of hypoperfusion/shock. Metoprolol tartrate and carvedilol mostly
used. (metoprolol tartrate is the only form of metoprolol that is cardio
protective.) blocks catecholamin and sympathetic nervous system. Cardio
protective, decreases arrhythmias, decreases HR and Contractility.
Decreases myocardial O2 consumption. Long term, decreases morbidity
and mortality. continued indefinitely. Educate patients on symptoms, may
feel exhausted, depressed.
, myocardial oxygen demand
The amount of oxygen required to avoid myocardial ischemia/hypoxia.
Myocardial cells normally use 75% of available oxygen, in contrast to other
tissues, which generally use 25% of available O2 in the bloodstream.
myocardial oxygen demand: decrease demand
lower preload, after load, HR, and contractility
myocardial oxygen demand: increase supply
oxygen; increase flow, such as NTG, ASA, anticoagulants; remove occlsions,
such as PTCA, CABG, Fibrinolytics
impedance cardiography
noninvasive estimate of CO, SVR, SV and other parameters using variations
in electrical impedance from chest sensors combined with basic
hemodyanamics such as BP and HR.
impedance Cardiography nursing application
insertion of a pa catheter is invasive and time consuming, PA catheters are
not advised for use when a pt has arrhythmias, coagulopathy, complete left
BBB, ebsteins anomaly, WPW syndrome, tricuspid or pulmonic stenosis, ToF
or RA/RV/ PA masses. In these cases, impedance cardiography may provid
some insight about a pts hemodynamic without increasing risks associated
with PA catheters.
EXAM ACTUAL COMPLETE REAL EXAM QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) ALREADY GRADED A+ |
GUARANTEED SUCCESS!! NEWEST EXAM | JUST RELEASED!!
asprin for treatment of STEMI
81 to 325 mg PO load (Chewed!) Onset of action 1 to 7.5 min. inhibits
cyclooxygenase 1 within platelets and prevents formation of thromboxane
A2. disables platelet aggregation. Monitor for intolerance and bleeding.
used indefinitely post MI. Maintenance dose for life at least 81 mg daily.
STEMI treatment: nitroglycerin
0.4 mg SL every 5 minuter times 3. Sublingual, spray or infusion, Tridil. May
use IV if continued chest discomfort/ symptoms. potent vasodilator, monitor
for hypotension, headache. Reduces preload and ventricular wall tension.
Decreases myocardial o2 consumption. Avoid if suspected right ventricular
infarction or use of phosphodiesterase inhibitors, Viagra or Cialis.
STEMI Treatment: O2 supplemental
only if sats < 94%. hyperoxemia perpetuates oxidative injury after MI, can
worsen and increase infarct size. Not needed for patients without
evidence of respiratory distress.
,STEMI Treatment: morphine
Small incremental doses IV Q5 to 15 min if chest pain is unrelieved by NTG. use
as adjunct therapy to NTG. Potent analgesic and anxiolytic. Causes
Venodilation and reduces preload mild afterload reduction. Decreases
workload of heart. Use Cautiously in UA and NStemi, increased mortality in
large patient registry. causes hypotension. Avoid if suspected right
ventricular infarction.
post PCI therapy: access site
radial artery access site is becoming more popular: fewer complications.
Monitor for arterial vasospasm.
Femoral: monitor for bleeding, hematoma, retroperitoneal bleeding. Rare
cases, can develop pseudoaneurysms, AV fistual.
post PCI Therapy: retroperitoneal bleeding
will see soft bp that is fluid responsive, Back pain, tachycardia; may not see
if patient received beta blockers. Late sign is flank ecchymosis (grey
turner's sign) assess coags, control bleeding. monitor renal function
closely (dye load)
post PCI medication management
Aspirin, (indefinitely) P2Y12 inhibitor (usually for 1 year), beta blocker
(indefinitely), statin (high dose indefinitely), ACE Inhibitor or ARB (if EF
<40%, indefinitely)
,P2Y12 inhibitors
Clopidogrel (Plavix) 300 to 600 mg load; continue 75 mg daily for 12 months
Prasugrel (Effient) 60 mg load; continue 10 mg for 12 months
Ticagrelor (Brilinta) 180 mg load; 90 mg BID for 12 months
Other recommendations: Unfractionated Heparin or Bivalirudin, angiomax:
used during PCI; finish in cath lab; half life 25 min with normal renal function.
Dose;
0.75 mg/kg IV bolus. Then 1.75mg/kg/hr IV infusion for duration of the
procedure. May continue for 4 hours post procedure.
Other recommendations: GP IIb/IIIA inhibitors at time of PCI
Abciximab, reopro. Eptifibatide, Integrilin. Tirofiban, Aggrastat. monitor
platelet count and for bleeding.
Beta blockers: oLOL
Start within 24 hours if hemodynamically stable. Hold if hypotension or
signs of hypoperfusion/shock. Metoprolol tartrate and carvedilol mostly
used. (metoprolol tartrate is the only form of metoprolol that is cardio
protective.) blocks catecholamin and sympathetic nervous system. Cardio
protective, decreases arrhythmias, decreases HR and Contractility.
Decreases myocardial O2 consumption. Long term, decreases morbidity
and mortality. continued indefinitely. Educate patients on symptoms, may
feel exhausted, depressed.
, myocardial oxygen demand
The amount of oxygen required to avoid myocardial ischemia/hypoxia.
Myocardial cells normally use 75% of available oxygen, in contrast to other
tissues, which generally use 25% of available O2 in the bloodstream.
myocardial oxygen demand: decrease demand
lower preload, after load, HR, and contractility
myocardial oxygen demand: increase supply
oxygen; increase flow, such as NTG, ASA, anticoagulants; remove occlsions,
such as PTCA, CABG, Fibrinolytics
impedance cardiography
noninvasive estimate of CO, SVR, SV and other parameters using variations
in electrical impedance from chest sensors combined with basic
hemodyanamics such as BP and HR.
impedance Cardiography nursing application
insertion of a pa catheter is invasive and time consuming, PA catheters are
not advised for use when a pt has arrhythmias, coagulopathy, complete left
BBB, ebsteins anomaly, WPW syndrome, tricuspid or pulmonic stenosis, ToF
or RA/RV/ PA masses. In these cases, impedance cardiography may provid
some insight about a pts hemodynamic without increasing risks associated
with PA catheters.
