Cardiovascular Nursing – Flashcards
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Women's hearts are:
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Smaller and have smaller cardiac arteries Cardiac arteries occlude more easily ↑ resting rate ↑ stroke volume ↑ ejection fraction
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Women tend to have atypical signs/symptoms of MI:
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-Shoulder/upper back pain -SOB -Fatigue.
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Diagnostic profile for acute MI
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Plasma analysis of key cardiac iso-enzymes and other bio-markers: -CK and CK-MB -Myoglobin -Troponin T and I
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Cholesterol
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-LDL: Normal less than 160mg/dl -HDL: women: 35-85, men: 35-70 -Triglycerides: Normal100-200 mg/dl.
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Brain (B-Type) Natriuretic Profile (BNP)
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-Secreted by the ventricular walls in response to an increase in preload or fluid in the ventricles -Used for diagnosis, monitoring and as a prognostic tool for Heart Failure -Results are quickly done.
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Blood Chemistry Tests related to Cardiovascular System
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-Na+ control of fluid volume -K+ major role in cardiac electrophysiologic function *Hypokalemia *Hyperkalemia -Ca++ *neuromuscular activity and automaticity *Hypocalemia *Hypercalemia -FBS or Hemoglobin A1C
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Electrocardiogram (ECG)
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-A graphic study of the electrical activity of the myocardium to determine transmission of cardiac impulses through the muscles/conduction tissue.
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Exercise Cardiac Stress Test
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-Walking on a treadmill - usually 9 to 12 minutes with increases in speed and incline of treadmill every 2 to 3 minutes based upon protocol used -Exercise bicycle - with increase in resistance at set intervals.
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Exercise Cardiac Stress Test Interventions
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-Pt. needs to fast for 4 hours before test and avoid stimulants (tobacco, caffeine) -Some cardiac medications (beta adrenergic blockers) may be held -Equipment to be used and need to have an IV -Symptoms to report during testing.
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Pharmacologic Cardiac Stress Imaging
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-Patients who cannot walk on treadmill or use exercise bike may undergo pharmacologic stress test with imaging -Vasodilation of coronary arteries with medications mimics the effect of exercise
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Cardiac Catheterization
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-Insertion of catheter into heart under fluoroscopy, to obtain information about oxygen saturations, structures, performance of valves, assess coronary artery perfusion, and pressure readings within heart chambers -Inserted into vein for right side of heart and artery for left side
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Nursing Responsibility for cardiac catheterization
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-Prior to procedure: *Confirm consent has been signed *NPO 8-12 hours *ECG monitoring *Patent IV line *Resuscitation equipment on hand -After procedure: *Assess site for hematoma, circulation to affected extremity, ECG, HR *Bed rest for 2-6 hours with leg straight *Monitor for chest pain.
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Cardiovascular Angiography
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-Done via cardiac catheterization -Dye injected into vessels during catheterization to make them visible on x-ray to check patency, injury, or aneurysms *Cardiac *Peripheral (carotid, renal, femoral).
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Blood Pressure Classification
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Systolic Diastolic Normal <120 <80 Hypertension <140-159 < 90-99
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Non-modifiable Risk Factors: Essential Hypertension
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-Family history -Age -Gender -Race & ethnicity
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Modifiable Risk Factors: Essential Hypertension
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-Obesity -Sedentary life style -Alcohol -Stress -Smoking -High sodium diet -Oral contraceptives -Decreased Estrogen -Elevated serum cholesterol
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Hypertension Clinical Manifestations
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-Usually NO symptoms other than elevated blood pressure -Symptoms seen related to vascular and organ damage *Left ventricular hypertrophy *Heart failure *Renal failure *Stroke - Are seen late and are serious.
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Hypertension Assessment and Diagnostic Evaluation
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-Retinal examination -Urinalysis for renal damage -Blood Chemistry *Electrolytes *FBS *Total and HDL cholesterol levels *BUN or Creatinine - 12 lead EKG -Chest x-ray.
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Lifestyle Modifications Hypertension
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-Weight reduction. -Dietary approaches. -Dietary sodium reduction. -Physical activity. -Moderation of alcohol consumption.
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Medical Management Hypertension
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-SBP 140 or less -DBP 90 or less Persons with diabetes mellitus or chronic renal disease have a lower goal pressure of 130/80.
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Use of Nitroglycerine
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-When pain occurs instruct patient to Stop activities and rest -Use NTG *Repeat every 5 minutes if pain is not relieved *Call 911 if the pain is not relieved in 15 minutes.
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Step Care Management of Hypertension
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-Step 1 Lifestyle modifications (Diet, exercise)
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Acute Coronary Syndrome or Acute Myocardial Infarction
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Life threatening condition characterized by the formation of localized necrotic area within the myocardium
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Stage 2 HTN without compelling indications
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-Continue lifestyle modifications -Usually on 2-drug combination -Thiazide diuretic (HCTZ) and ACE-1/ARB/BB/CCB
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MI
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-Unrelieved ischemia of > 15 minutes causes irreversible damage to the myocardium (necrosis) -Area of the myocardium is permanently destroyed.
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MI Symptoms
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-Shortness of breath, indigestion, nausea, anxiety -Cool, pale and moist skin. -Symptoms cannot always be distinguished .
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MI Pharmacological Therapy
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-ASA 162-325 mg -Nitroglycerin -Morphine -Beta-blocker -Heparin -ACE inhibitor within 24 hours (acts on BP).
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MI Other therapies
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-Oxygen -Bed rest -Continuous ECG monitoring -Evaluate for indications for reperfusion therapy *Percutaneous coronary intervention *PTCA -Percutaneous Transluminal *Coronary Angioplasty *Coronary Artery Stent Placement *Artherectomy *Thrombolytic therapy.
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ACE inhibitors
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-ACE -I (drugs ending in "pril" captopril) -Inhibit conversion of angiotension I to angiotension II resulting in reduced salt and water retention.
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Nursing Implications: ACE
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-Hypotension reversed by fluid replacement -Used with thiazide diuretic and digoxin.
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Angiotensin Receptor Blockers (ARB)
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-Angiotensin receptor blockers (drugs ending in "sartan" losartan or Cozaar) -Block the effects of angiotensin II at the receptor site. -Reduces peripheral resistance.
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Nursing Implications: ARB
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-Monitor for hyperkalemia.
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Aldosterone antagonists (ALDO ANT)
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-Methyldopa (Aldomet), clonidine (Catapres) -Acts on CNS, affecting norepinephrine
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Nursing Implications: ALDO ANT
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-Rebound htn is common (educate continue taking to avoid rebound) -SE: dry mouth, drowsiness dizziness, nasal congestion, severe depression, constipation, fatigue, headache, sleepiness.
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Beta Blockers
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-Drugs ending in "olol" atenolol -Block the sympathetic nervous system (beta-adrenergic receptors) to slow heart, reduce its pumping force and lower BP.
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Nursing Implications Beta Blockers
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-Check heart rate (↑60) and BP before giving -May cause mental depression -Indicated for patients with stable and silent angina -Avoid sudden discontinuation.
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Calcium Channel Blockers
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(diltiazem) Cardiazem , (amlodipine) Norvasc -Inhibits the movement of calcium into the cardiac and smooth muscle cells -Smooth muscle tone is lost which causes vasodilation in coronary and peripherial arteries.
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Calcium Channel Blockers Nursing Implications
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-Assess for irregular heart, dizziness or edema -Do not discontinue suddenly (risk for depression) -Observe for hypotension.
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Percutaneous Coronary Intervention
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-Percutaneous transluminal coronary angioplasty (PTCA) is used to open blocked coronary arteries and resolve ischemia -Balloon, at tip of catheter, is inflated and plaque is pushed against the wall -Stent may be placed over the balloon and left in place -Fluoroscopy is used to guide catheter.
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Improve Respiratory Function
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-Administer O2 and monitor saturations levels -T, C, DB -Prevent fluid overload in lungs
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Relieving Pain and Other Signs/Symptoms of Ischemia
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-Administration of medications -Oxygen therapy -Bed rest with elevation of head and torso.
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Promote adequate tissue perfusion
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-Bedrest -Oxygen therapy.
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Valvular Heart Disease
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Occurs when valves are compromised and do not open and close properly.
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Classification of Valvular Heart Disease
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-Stenosed valves Narrow opening that reduces the flow of blood from one chamber to the next. -Insufficient (incompetent) valve Improper closure of valve that allows blood to regurgitate (flow backward) and returns to the chamber it came from. -Prolapse Stretching of an atrioventricular heart valve leaflet into the atrium during systole.
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Nursing Management and Process
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-The diagnosis -Progressive nature of the disease -Teatment plan -Signs and symptoms of heart failure -To report new symptoms or changes in -symptoms to the health care provider -The need for prophylactic antibiotic therapy before any invasive procedure.
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Diuretics
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-Loop diuretics Lasix (furosemide) -Thiazide diuretics (hydrochlorothiazide, hydrothiazide) -Potassium sparing diuretics.
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Process for the Patient with Hypertension
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Assessment -Proper measuring of BP at frequent intervals -Assess apical and peripheral pulse -Monitor electrolytes and instruct patient on electrolyte replacement therapy if applicable.
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Dysrhythmias
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Life threatening (Ventricle dysrhytmias) -Ventricular tachycardia (Flush back) -Ventricular fibrillation (quiver) -Asystole (no heart activity) (Decrease cardiac output and tissue perfusion)
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Benign
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-Premature atrial contractions (PAC) -Premature ventricular contractions (PVC) Coffee excess.
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Coronary Artery Disease
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-There are no symptoms in 80% of patients -Must be a critical deficit in blood supply to heart in proportion to demands for oxygen and nutrients -Most common manifestation of myocardial ischemia is acute onset of chest pain.
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Coronary Artery Disease symptoms
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-Continuum related to location and degree of vessel obstruction -Angina pectoris -Myocardial infarction -Heart failure -Sudden cardiac death.
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Angina Pectoris
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Clinical syndrome usually characterized by episodes of pain or pressure in anterior chest, caused by insufficient coronary blood flow.
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Angina Precipitating Factors
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-Physical exertion -Temperature extremes -Eating a heavy meal -Emotional stress -Smoking -Sexual activity.
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Types of Angina
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-Stable -Unstable.
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Stable Angina
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-Infrequent predictable and consistent pain -Occurs on exertion, by a predictable degree of exercise -Treatable with rest or nitroglycerides or both.
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Unstable Angina
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-Triggered by an unpredictable degree of exertion or emotions -May occur at rest and last longer than stable angina -Increasing frequency and severity over time that is not relieved by rest and NTG.
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Angina Diagnostic Findings
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-ECG Resting Exercise -Coronary Angiogram Remains the gold standard in diagnosing the percentage of blockage in coronary arteries.
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Angina Pharmacologic Therapy
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-Nitrates *Dilates vessels, causing decreased peripheral resistance, decreased BP and pooling of blood in the body -ß adrenergic blockers *Decrease HR, BP and contractility of heart -Calcium channel blockers *Act on SA node to slow heart rate and decrease strength of heart muscle contraction -Antiplatelet and Anticoagulants *Prevents platelet aggregation and subsequent thrombosis, which impedes blood flow -Oxygen
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Endocarditis Nursing Management and Process.
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-Diagnosing and treating group A beta-hemolytic streptococcal pharyngitis (common in school-age children) can prevent rheumatic fever and rheumatic heart disease -Teaching people to recognize and seek medical treatment for streptococcal pharyngitis.
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Endocarditis Symptoms
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-Fever (intermittent/absent) -Heart murmur -Headache -Small, painful nodules on fingers.
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Endocarditis Nursing Management
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-Monitor temperature -Assess heart sounds -Signs and symptoms of embolization and organ damage.
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Myocarditis
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-Uncommon infection of the heart muscle caused by viral, bacterial or fungal infection -Infection causes immune response which damages heart muscles causing dilation of heart and degeneration of heart muscles -Presenting symptoms are flu-like -Organism must be identified and then treated.
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Myocarditis Nursing Management
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-Treat infections -Rest -Fluids -Monitor for dysrhythmias (SOB, Skips) -Monitor for heart failure.
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Pericarditis
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-Inflammation of the pericardium (membranous sac that surrounds heart) -Has multiple causes : bacteria, virus, fungus, parasites, renal failure, MI, chest trauma.
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Pericarditis Symptoms
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-Creaky or scratchy friction rub heard most clearly at the left lower sternal border -Chest pain that becomes worse when the patient takes a deep breath or lie down -May be relieved when patient leans forward and/or is in sitting position.
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Pericarditis Nursing Management
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-Assess and treat pain -Bed rest to promote healing -Elevate HOB and lean forward to decrease pain and dyspnea -Education and reassurance that the pain is not a heart attack -Monitor for heart failure.
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Right Sided Heart Failure
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-Blood backs up into the systemic circulation. -Fluid accumulates behind the chambers that fail first. -Congestion occurs in the liver, gastrointestinal tract and periphery (arms and legs).
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Right Side Heart Failure Clinical Manifestation
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-Pronounced jugular neck vein (JVD). -Pitting edema (Peripheral/Perineal/sacral). -Ascitis (Pain). -Hepatomegaly. -Weight gain. (2-3 lbs in 1 day or 5 lb in 1 week) -Increase urine output. -Frequent nocturnal urination.
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Left Sided Heart Failure
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-Blood backs up into the pulmonary system causing pulmonary congestion or fluid in the lungs. -Cardiac output is decreased which means less blood enters the systemic circulation -The body than does not receive oxygen and nutrients.
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Left Sided Heart Failure Clinical Manifestation
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-Pulmonary congestion/edema *Dyspnea *Orthopnea *PND paroxysmal nocturnal dyspnea *Cough that is dry at first but than becomes moist over time and is sometimes blood tinged *Crackles (Dry cough).
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Left Sided Heart Failure Clinical Manifestation (2)
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-Decreased cardiac output *Decreased oxygen saturation *Cerebral hypoxia/ Confusion *Oliguria (decreased urine output) *Weak pulses *Fatigue and weakness -Clinical Manifestations of Heart Failure may not be detected until the disease is advanced
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Heart Failure Diagnostic
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-B-type natriuretic peptide (BNP) is key indicator of Heart Failure -Low pulse oximetry readings <90% -X-ray may reveal fluid infiltrates.
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ACE inhibitors
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-Promote vasodilatation and diuresis decreasing blood volume, resulting in a decrease in the heart's workload -May be the first medication prescribed -Monitor patient for hyperkalemia and hypotension.
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Beta-blockers
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-Reduces stimulation and slows the heart -Side effects may include dizziness, hypotension and bradycardia. -Hold them if Bp is >60 Bpm
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Digitalis: digoxin (Lanoxin)
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-Increases force of myocardial contraction and slows conduction through AV node -CO is increased and body is better perfused. -Small therapeutic window.
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Therapies Heart Failure
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-Nutritional Therapy *Low-sodium (2-3 g/day) diet *Avoid excessive fluid intake -Oxygen therapy *May become necessary as heart failure progresses *Based on patient SpO2.
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Heart Failure Nursing Planning and Interventions
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-Promoting Activity Tolerance *Goal should be for patient to engage in 30-45 minutes of physical activity per day *Choice of exercise needs to consider other medical conditions *Enroll in rehabilitation program.
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Heart Failure Nursing Planning and Interventions (2)
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-Managing Fluid Volume *Administer medications *Assess fluid balance (I & O/Weigh patient daily/Dependent edema [gravity based]) Auscultate lung sound for crackles) *Determine the degree of jugular venous distention *Monitor apical pulse for rate, rhythm and extra heart sounds. (Due to extra pressure) *Monitor blood pressure. *Assess skin turgor and mucous membranes. *Assess for symptoms of fluid overload.
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Report immediately to the physician or clinic
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-Weight gain of more than or equal to 2-3 lbs in 1 day or 5 lb in 1 week -Loss of appetite -Unusual shortness of breath with activity -Swelling of ankles, feet or abdomen -Persistent cough -Development of restless sleep; increase in the number of pillows needed to sleep
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Atherosclerosis
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Accumulation of lipids, calcium, blood components, and fibrous tissue on the intima of large and medium-sized arteries.
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Atherosclerosis Risk Factors
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-Modifiable *Nicotine *Diet *Hypertension *Diabetes *Obesity *Stress *Sedentary lifestyle *C-reactive protein
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Peripheral Vascular Disorders Symptoms
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Depends on the organ or tissue affected -Intermittent claudication - hallmark Aching/cramping that occurs with same degree of exercise or activity and relieved with rest -Pain at rest.
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Arteriosclerosis Prevention and Medical Management
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-Modification of Risk Factors -Lower cholesterol *Diet *Medications -Maintain normal blood pressure -Smoking cessation -Increasing activity -Manage diabetes -Surgery to clear occlusion in artery.
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Arteriosclerosis Nursing Diagnosis
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-Ineffective or altered peripheral tissue perfusion r/t compromised circulation -Chronic pain r/t impaired ability of peripheral vessels to supply tissues with oxygen -Risk for Impaired Skin Integrity r/t decreased peripheral circulation -Deficient knowledge regarding self-care activities.
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Arteriosclerosis Nursing interventions
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-Improving Peripheral Arterial Circulation *Position of extremity *Exercise -Promoting Vasodilation and Preventing *Vascular Compression *Smoking cessation. *Warm blanket to abdomen. *Avoid cold temperatures. *Adequate loose fitting clothing.
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Arteriosclerosis Nursing interventions (2)
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-Relieving Pain *Analgesic administration *Slow increase in exercise and formation of collateral circulation -Maintaining Tissue Integrity *Avoid trauma to area *Sturdy, well fitting foot wear. *Careful examination and care of feet. *Good nutrition for cell health.
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Arteriosclerosis Medical Management
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-Avoid particular stimuli *Cold *Tobacco *Stress -Pharmacologic *Calcium channel blocker (nifedipine: low dose vasodilator)
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Buerger's Disease:
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-Recurring inflammatory process of small and intermediate vessels -Most often occurs in men ages 20-35 -Generally in lower extremities.
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Raynaud's Disease
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-Intermittent arterial vaso-occlusion, usually of the fingertips or toes -Brought on by trigger such as cold or stress -Often occurs in young women. -White hands.
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Venous Thrombosis Causes
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-Endothelial damage (Surgery) -Venous stasis (rest) -Altered or hyper-coagulation (surgery, hepatic diseases, Birth control pills)
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Thrombosis Clinical Manifestations
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-Edema and swelling. -Warm skin and erythema. -Tenderness. -Homans is an unreliable sign.
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Pulmonary Embolism Symptom
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-SOB
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Venous Stasis
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-Results from obstruction of venous valves in legs or a reflux of blood through the valves.
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Chronic Venous Stasis Clinical Manifestations.
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-Edema -Altered pigmentation in gaiter area -Pain -Stasis dermatitis -Skin is dry, cracked, itches and can easily become infected.
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Reduce venous stasis and prevent ulcerations
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-Avoid prolong standing, sitting or crossing the legs -Elevation of legs above the heart -Sleep with the foot of the bed elevated -Use of elastic compression stockings
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Arterial Ulcers
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-Typically small, circular and deep -On tips of toes or in the web spaces between the toes -Gangrene of toe results from trauma to area -Pain is described as intermittent claudication. -No Edema (not enough blood)
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Venous Ulcers
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-Feet and ankles are edematous -Ulcerations are in area of the medial or lateral malleolus -Typically are large, superficial and highly exudative -Superficial (Not Deep)
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Varicose Veins
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-Abnormally dilated, tortuous, superficial veins caused by incompetent venous valves -Impaired blood return due to incompetent valves -Seen more frequently in women and in people whose occupations require prolonged standing.
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Varicose Veins Clinical Manifestations
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-Dull aches, muscle cramps, increased muscle fatigue, ankle edema and heaviness of the legs -Cause of chronic venous insufficiency -More susceptible to injury and infections.
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Varicose Veins Nursing Process
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-Instruct patient to avoid standing for extended periods of time -Elevate legs when seated -Compression stocking should be worn -Weight reduction -Exercise Weight reduction, if factor
