PCCN Cardio - CCRN Review Cardiovascular Leanna R Miller RN...

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10/16/2014 1 CCRN Review Cardiovascular Leanna R. Miller , RN, MN, CCRN-CMC, PCCN-CSC, CEN, CNRN, CMSRN, NP Education Specialist LRM Consulting Nashville, TN CCRN Review - Cardiovascular Angina Definition discomfort that occurs when oxygen demand exceeds oxygen demand Angina Classifications stable unstable Prinzmetal’s CCRN Review - Cardiovascular
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10/16/2014 2 Angina Classifications Class I: strenuous activity Class II: more prolonged or rigorous Class III: daily activity Class IV: angina @ rest CCRN Review - Cardiovascular Angina Etiology smoking hypertension obesity hyperlipidemia CCRN Review - Cardiovascular Angina Etiology diabetes sedentary life style cocaine use low serum folate CCRN Review - Cardiovascular
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10/16/2014 3 Angina Diagnostics ECG T wave inversion ST segment depression Lab ABGs H & H Enzymes (troponin & CK MB) Echocardiogram Clinical symptoms CCRN Review - Cardiovascular Angina Clinical Presentation pain (30 seconds to 30 minutes) associated symptoms CCRN Review - Cardiovascular Treatment modify risk factors correct aggravating factors CCRN Review - Cardiovascular
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10/16/2014 4 Treatment oxygen aspirin nitrates E - adrenergic blocking agents calcium channel blockers heparin glycoprotein IIb / IIIa inhibitors CCRN Review - Cardiovascular Myocardial Infarction necrosis resulting from insufficient supply of oxygenated blood to an area of the heart complete necrosis occurs within 4 6 hours of total occlusion CCRN Review - Cardiovascular Myocardial Infarction Types Non Q wave (ST segment elevation, depression or no change and T wave inversion on indicative leads) Q wave (significant Q wave in presence of acute changes) CCRN Review - Cardiovascular
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10/16/2014 5 Myocardial Infarction Epidemiology > 500,000 MI / year Males (40 65); equality after 65 years of age Women experience more lethal and severe 1 st MI CCRN Review - Cardiovascular Myocardial Infarction Etiology artherosclerosis coronary artery spasm coronary embolism coronary artery dissection MI with normal coronary arteries CCRN Review - Cardiovascular Myocardial Infarction Clinical Presentation pain (lasts > 30 minutes) associated symptoms no pain in about 20% of patient experiencing MI CCRN Review - Cardiovascular
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10/16/2014 6 Myocardial Infarction Diagnostics 12 lead ECG (18 lead) enzymes echocardiography clinical symptoms CCRN Review - Cardiovascular Myocardial Infarction 12 lead ECG Inferior II, III, aVF Anterior V 2 6 Lateral I, aVL, V 5-6 Posterior V 1 or V 7 - 9 CCRN Review - Cardiovascular Myocardial Infarction 12 lead ECG Anterolateral I, aVL, V 2 6 Inferolateral II, II, aVF, I, aVL, V 5 6 Right ventricular V 3 R, V 4 R CCRN Review - Cardiovascular
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10/16/2014 7 Myocardial Infarction Treatment bed rest (1 st 24 hours) NPO until stable, low cholesterol, low Na patient education CCRN Review - Cardiovascular Myocardial Infarction Treatment Oxygen Nitrates Analgesia (MS) aspirin CCRN Review - Cardiovascular Myocardial Infarction thrombolytic therapy tPA (TNK) rPA CCRN Review - Cardiovascular
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10/16/2014 8 Myocardial Infarction Treatment E - adrenergic blocking agents ACE inhibitors
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