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Oxygenation and Perfusion CAD
Study
Collaborative management
The coordinated efforts of multiple healthcare professionals to manage a patient's condition.
Identification of high risk for CAD
The process of identifying individuals who are at an increased risk for coronary artery disease (CAD).
Health history
A collection of information about a patient's past and present health conditions, including their medical history and any preexisting conditions.
Physical history
A record of a patient's physical characteristics and any abnormalities or changes that may be relevant to their health.
Environmental factors
External factors that can contribute to the development or progression of a disease, such as exposure to toxins or pollutants.
Psychosocial
Referring to the influence of psychological and social factors on an individual's health and well-being.
Employment history
A record of a patient's past and present employment, including any occupational hazards or exposures that may impact their health.
Health attitudes
A person's beliefs, opinions, and behaviors related to their health and healthcare practices.
Educational background
A person's level of education and knowledge, which can impact their understanding and ability to manage their health.
Management of risk factors
Strategies and interventions aimed at reducing or controlling the factors that contribute to the development of a disease, such as lifestyle modifications or medication.
Healthy diet
A balanced and nutritious eating plan that is rich in fruits, vegetables, whole grains, lean proteins, and healthy fats.
Exercise
Physical activity that is planned, structured, and repetitive for the purpose of improving or maintaining physical fitness and overall health.
Medications
Prescribed or over-the-counter drugs used to treat or manage a specific health condition.
Healthy weight
A weight range that is considered optimal for an individual's height, age, and body composition, and is associated with a reduced risk of chronic diseases.
Stop smoking
Cessation of tobacco use, which is an important step in reducing the risk of cardiovascular disease and other health problems.
Alcohol
The consumption of alcoholic beverages, which should be done in moderation to minimize the risk of adverse health effects.
Stress reduction
Techniques and activities aimed at reducing or managing stress, such as relaxation exercises, meditation, or counseling.
Antiplatelet therapy
The use of medications that prevent the aggregation of platelets in the blood, which is important for reducing the risk of blood clots and cardiovascular events.
Vasodilators
Medications that cause the blood vessels to relax and widen, which can help to lower blood pressure and improve blood flow.
ACE Inhibitors
A class of medications that inhibit the action of the angiotensin-converting enzyme (ACE), which helps to control blood pressure and reduce the workload on the heart.
Beta blockers
Medications that block the effects of adrenaline and reduce heart rate and blood pressure, which can be beneficial in managing cardiovascular conditions.
Calcium channel blockers
Medications that inhibit the movement of calcium into the cells of the heart and blood vessels, which can help to relax the blood vessels and improve blood flow.
Time is muscle
The concept that time is critical in the treatment of a heart attack, and the sooner blood flow is restored to the heart muscle, the better the outcome and chance of preserving heart function.
Initial actions upon presentation
The immediate steps taken when a patient presents with symptoms of a cardiac event, such as assessing the patient, providing oxygen, establishing intravenous access, and obtaining baseline labs and imaging.
ABCs
An acronym for Airway, Breathing, and Circulation, which are the primary focuses in the initial assessment and management of a patient in a critical condition.
Assessment
The process of gathering information and evaluating a patient's condition, including vital signs, symptoms, and medical history, in order to make a diagnosis and develop a treatment plan.
VS
An abbreviation for vital signs, which typically include measurements of the patient's blood pressure, heart rate, respiratory rate, and temperature.
Rhythm
The regularity or pattern of electrical impulses in the heart, which can be evaluated through various tests, such as an electrocardiogram (ECG).
Pain
An unpleasant sensation that can range from mild to severe and is often an indicator of tissue damage or disease.
IV access
The establishment of a intravenous route for the administration of fluids, medications, or other treatments directly into the bloodstream.
Baseline labs
Initial laboratory tests that provide a reference point for comparison and help to assess a patient's overall health and organ function.
Imaging
Techniques or procedures that create visual representations of the internal structures of the body, such as x-rays, CT scans, or echocardiograms.
Treat pain
To provide relief and manage pain through the use of analgesic medications, such as opioids or nonsteroidal anti-inflammatory drugs (NSAIDs).
Risk for anticoagulation
The potential for complications related to the use of anticoagulant medications, such as bleeding or blood clots.
Unstable angina vs Myocardial infarction
Unstable angina is chest pain or discomfort that occurs at rest or with minimal exertion and may indicate an impending heart attack, while myocardial infarction (heart attack) refers to the death of heart muscle tissue due to a blocked blood supply.
Reperfusion therapy
Medical procedures or treatments that aim to restore blood flow to an area of the body that has been deprived of adequate oxygenation, such as in the case of a heart attack.
Percutaneous coronary intervention (PCI)
A minimally invasive procedure used to widen narrowed or blocked blood vessels in the heart, typically using a balloon-tipped catheter to compress plaques and a stent to keep the vessel open.
Angioplasty
A procedure used to open narrowed or blocked blood vessels by inflating a tiny balloon inside the vessel, which helps to restore blood flow.
Stent
A small mesh tube that is inserted into a blood vessel to help support and keep it open, typically used after angioplasty to prevent the vessel from narrowing again.
Advantages
The benefits or positive aspects of a particular treatment or intervention.
Complications
Unintended or adverse events that may occur as a result of a medical treatment or intervention.
Thrombolytics
Drugs that can dissolve blood clots and restore blood flow in conditions such as heart attacks or strokes.
Inclusion criteria
Specific characteristics or factors that make an individual eligible for inclusion in a clinical trial or research study.
Protocol
A detailed plan or set of guidelines that outlines the study design, procedures, and objectives of a clinical trial or research study.
Coronary artery bypass graft (CABG)
A surgical procedure used to bypass blocked or narrowed coronary arteries by creating new paths for blood to flow to the heart muscle.
Indications
Medical reasons or criteria that indicate the need for a specific treatment or intervention.
Procedure
A series of steps or actions taken to achieve a specific outcome or objective, often involving medical or surgical techniques.
Types
Different variations or approaches within a specific category or classification.
MID CAB
A minimally invasive surgical approach for coronary artery bypass grafting that involves a smaller incision and avoids the use of cardiopulmonary bypass.
OP CAB
An off-pump coronary artery bypass grafting procedure, in which the heart continues to beat during the surgery and a heart-lung machine is not used.
Robotics
The use of robotic systems or technologies to assist or perform surgical procedures with enhanced precision and minimal invasiveness.
Laser
A high-intensity beam of light that can be used in surgical procedures to cut, coagulate, or vaporize tissue.
IV nitroglycerin
Intravenous administration of nitroglycerin, a medication that relaxes blood vessels and increases blood flow, commonly used to treat chest pain or angina.
Dual antiplatelet therapy
The use of two different antiplatelet medications, such as aspirin and a P2Y12 inhibitor, to reduce the risk of blood clots and cardiovascular events.
Systemic anticoagulation
The administration of anticoagulant medications that work throughout the body to prevent the formation of blood clots.
Morphine
A potent opioid analgesic that is used to relieve severe pain, such as that associated with a heart attack.
Antilipidemics
Medications used to lower blood lipid levels, such as cholesterol and triglycerides, in order to reduce the risk of cardiovascular disease.
Components of a focused assessment of a patient with CAD
Identification of high risk for CAD, Health history, Physical history, Environmental factors, Psychosocial, Employment history, Health attitudes, Educational background
Goals and outcomes based on data analysis for patients with CAD
Management of risk factors, Healthy diet, Exercise, Medications, Healthy weight, Stop smoking, Alcohol moderation, Stress reduction, Antiplatelet therapy, Vasodilators, ACE Inhibitors, Beta blockers, Calcium channel blockers
Nursing role in collaborative management with the promotion of therapeutic lifestyle changes in the patient with CAD
Health education and counseling, Monitoring and evaluating patient adherence to lifestyle changes, Collaborating with other healthcare professionals
Evaluation of progress toward outcomes for the patient with CAD
Regular assessment of risk factors, Monitoring of medication adherence, Evaluation of lifestyle changes, Review of diagnostic test results
Collaborative care and nursing management of the patient with ACS and chronic stable angina
Differentiating between unstable angina and myocardial infarction, Reperfusion therapy (PCI or thrombolytics), Management of pain, Risk assessment for anticoagulation, Education on medications and lifestyle modifications
Clinical characteristics, assessments, interventions, and treatment of normal sinus rhythm and common dysrhythmias
Assessment of vital signs, EKG monitoring, Intervention for symptomatic dysrhythmias, Treatment options including medications, cardioversion, and defibrillation
Comparison of synchronized cardioversion and defibrillation
Synchronized cardioversion is used for certain dysrhythmias with a lower energy shock, while defibrillation is used for life-threatening dysrhythmias with a higher energy shock
Key components to include in the rehabilitation of patients recovering from ACS and coronary revascularization procedures
Cardiac monitoring, Medication management, Physical activity and exercise, Dietary modifications, Psychosocial support, Smoking cessation, Education on managing risk factors
Collaborative management of CAD
Medical management including medication therapy and interventions, Lifestyle modifications, Monitoring and managing risk factors, Education and counseling
Use of dual antiplatelet therapy in CAD
Dual antiplatelet therapy includes the use of both aspirin and another antiplatelet medication (such as clopidogrel) to reduce the risk of clot formation and future cardiovascular events
Systemic anticoagulation in CAD
Systemic anticoagulation is used to prevent the formation of blood clots in patients with CAD, reducing the risk of myocardial infarction and other cardiovascular events
Medications commonly used in CAD management
Morphine for pain management, Beta blockers to reduce heart rate and blood pressure, ACE inhibitors to decrease blood pressure and improve blood flow, Antilipidemics to lower cholesterol levels
Dysrhythmias
Study
Dysrhythmias
Abnormal heart rhythm
What is a dysrhythmia?
An abnormal heart rhythm that can affect the normal electrical conduction of the heart
What do dysrhythmias affect?
Normal electrical conduction, depolarization, repolarization, autonomic nervous system
Normal electrical conduction
The normal flow of electrical impulses through the heart
Depolarization
The contraction of the heart muscle cells
Repolarization
The relaxation of the heart muscle cells
Autonomic Nervous System
The part of the nervous system that controls involuntary body functions
Sympathetic Nervous System
The part of the autonomic nervous system that is responsible for the 'fight or flight' response
Parasympathetic Nervous System
The part of the autonomic nervous system that is responsible for the 'rest and digest' response
Electrocardiogram (ECG)
A test that measures the electrical activity of the heart
12 lead ECG
An ECG that uses 12 different leads to measure the electrical activity of the heart from different angles
Bedside Cardiac Monitor
A device that continuously monitors a patient's heart rhythm
Telemetry
A remote monitoring system that allows healthcare providers to monitor a patient's heart rhythm from a central station
Holter Monitor
A portable device that records a patient's heart rhythm for 24-48 hours
Waveforms and Intervals
The different patterns and timings seen on an ECG
P wave
The first peak in an ECG waveform, representing atrial depolarization
QRS Complex
The complex shape in an ECG waveform, representing ventricular depolarization
T wave
The peak in an ECG waveform, representing ventricular repolarization
PR Interval
The time between the P wave and the start of the QRS complex, representing the delay in the AV node
PRI (pregnancy)
P-wave Rate Interval
ST segment
The flat line between the QRS complex and the T wave, representing ventricular repolarization
QT interval
The time from the start of the QRS complex to the end of the T wave, representing ventricular depolarization and repolarization
Determining Heart Rate
Calculating the number of heart beats per minute
Examination of the ECG paper
Analyzing the different components and measurements on the ECG graph paper
Small square
0.04 sec
1500 small squares
6 seconds
Large square
0.20 sec
300 large squares
6 seconds
Methods to approximate HR when regular 6 second strip
Count small or large squares, memorize mnemonic: 300, 150, 100, 75, 60, 50, 43, 32
Rhythm Analysis
Evaluating the regularity and characteristics of the heart rhythm
Origin of the rhythm
Where the electrical impulse that causes the heart rhythm originates
SA node (sinoatrial node)
The natural pacemaker of the heart, located in the right atrium
Atrium
The upper chambers of the heart
AV node (atrioventricular node)
The electrical bridge between the atria and ventricles
Ventricle
The lower chambers of the heart
Bundle branches or Purkinje fibers
The specialized conduction pathways in the ventricles
Analyze the rate
Assessing the number of heart beats per minute
Look at R-R interval (regular or irregular)
Measuring the distance between consecutive R waves on the ECG
Look at PQRST (early or abnormal complexes)
Identifying any abnormalities or irregularities in the PQRST waveforms on the ECG
Define the rhythm
Determining the specific type of heart rhythm based on the characteristics observed on the ECG
Normal Sinus Rhythm Characteristics
Ventricular and atrial rate: 60-100 (adult), Ventricular and atrial rhythm: regular, P-wave: normal and consistent shape, and always in front of QRS, QRS: usually normal, PRI (PR Interval): consistent interval of 0.12-0.20 sec, PQRS ratio: 1:1, Typical signs and symptoms
Nursing Implications for Rhythm Analysis
Understanding the implications for patient care based on the specific type of heart rhythm observed
Sinus Bradycardia
HR <60, symptomatic
Sinus Tachycardia
HR >100, symptomatic
Sinus Dysrhythmia/Arrhythmia
A variation in the heart rate that follows the patient's respirations, generally asymptomatic and no treatment needed
Premature Atrial Contractions
Early and abnormal atrial complexes, may or may not have symptoms
Atrial Flutter
Rapid atrial rate, atrial rhythm regular, sawtooth-shaped P waves, symptomatic
Atrial Fibrillation
Chaotic atrial rate, atrial rhythm irregular, absence of distinct P waves, symptomatic
Junctional Rhythm
Heart rate: 40-60 BPM, symptomatic
Premature Ventricular Contractions
Early, wide, and bizarre ventricular complexes with or without symptoms, complete compensatory pause
Ventricular Tachycardia
A run of wide and bizarre ventricular complexes, symptomatic
Ventricular Fibrillation
Chaotic, disorganized, and irregular ventricular activity, no identifiable waveforms, symptomatic
Ventricular Asystole
Complete absence of ventricular activity, no pulse, symptomatic
Heart Blocks
Impaired conduction between the atria and ventricles
1st Degree Atrioventricular Block (AVB)
PR interval prolonged (>0.20 sec), but consistent, no other abnormalities, no treatment necessary
2nd Degree AVB Type I (Wenckebach)
Progressive prolongation of the PR interval until a QRS complex is dropped, symptomatic
2nd Degree AVB Type II
Intermittent non-conducted P waves without progressive prolongation of the PR interval, symptomatic
3rd Degree AVB (Complete Heart Block)
Atria and ventricles beat independently, symptomatic
Management of Dysrhythmias
Treatment options for abnormal heart rhythms
Medications
Pharmacological agents used to control or correct heart rhythm abnormalities
Valsalva Maneuvers
Breathing techniques that can help regulate heart rhythm
Carotid sinus massage
Gentle pressure on the carotid sinus to stimulate the vagus nerve and slow down the heart rate
Bearing down
Straining the abdominal muscles to increase intra-abdominal pressure and stimulate the vagus nerve
Inducing a gag reflex
Stimulating the back of the throat to activate the vagus nerve and slow down the heart rate
Automatic External Defibrillator (AED)
A device used to deliver an electric shock to the heart to restore a normal rhythm
Cardioversion
A procedure that uses an electric shock to restore a normal heart rhythm, usually requires sedation
Defibrillation
A procedure that uses a higher-energy shock to restore a normal heart rhythm, used for pulseless ventricular tachycardia and ventricular fibrillation
Pacemakers
Devices implanted in the chest that deliver electrical impulses to regulate the heart rhythm
Transcutaneous
Pacemaker Placement on the skin surface
Sedation/Analgesics
Medications used to help the patient relax and manage pain during pacemaker placement
Transvenous
Pacemaker Placement through a vein
Assessment of insertion site
Checking for signs of infection or complications at the pacemaker insertion site
Permanent Pacemaker
A pacemaker that is implanted long-term to regulate the heart rhythm
Implantable Cardioverter Defibrillator
A device that combines the function of a pacemaker and a defibrillator, used to monitor and treat life-threatening arrhythmias
Electrophysiological Studies
Procedures used to diagnose and evaluate heart rhythm disorders
Ablation
A procedure that uses heat or cold to destroy tissue causing abnormal heart rhythms
Surgical Intervention
Surgery to correct underlying heart problems that may contribute to dysrhythmias
Maze Procedure
A surgical procedure that creates a pattern of scar tissue in the atria to redirect electrical impulses and restore a normal heart rhythm
ECG changes associated with ACS
Changes in the ECG waveform that indicate acute coronary syndrome (heart attack)
Ischemia
T-wave inversion, ST depression
Injury/Infarction
ST elevation, Q wave
Acute decompensated heart failure
Study
What is the first-line treatment for acute decompensated heart failure?
Intravenous loop diuretics (e.g. furosemide)
What is the goal of diuretic therapy in acute decompensated heart failure?
To relieve pulmonary congestion and reduce edema
What is the role of vasodilators in the treatment of acute decompensated heart failure?
To reduce afterload and improve cardiac output
Which vasodilators are commonly used in the treatment of acute decompensated heart failure?
Nitroglycerin and nitroprusside
What is the role of inotropic agents in the treatment of acute decompensated heart failure?
To improve myocardial contractility and cardiac output
What are some commonly used inotropic agents in the treatment of acute decompensated heart failure?
Dobutamine and milrinone
What is the role of beta-blockers in the treatment of acute decompensated heart failure?
To reduce heart rate, improve ventricular filling, and prevent arrhythmias
When are beta-blockers contraindicated in the treatment of acute decompensated heart failure?
In the presence of cardiogenic shock or severe hypotension
What is the role of oxygen therapy in the treatment of acute decompensated heart failure?
To correct hypoxemia and reduce myocardial workload
What is the role of fluid restriction in the treatment of acute decompensated heart failure?
To prevent volume overload and reduce edema
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A summary of nursing flashcards covering Oxygenation and Perfusion CAD, collaborative management, and risk identification.
Nursing
Health History
Physical History
Environmental Factors
Psychosocial
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