Med Surg 3 Final
Exam Review
Med Surg 3 Final Exam
Review
Cardiac (24)
MAP: > 65 for adequate blood flow to major organs (MAP= 2x diastolic +
... [Show More] 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” [Show Less]