Cardiovascular System And Nursing Implications2

Front 1

Medical management of CHF

Back 1

-rest
-fluid restricted
-oxygen
-medications

Front 2

Medications to manage CHF

Back 2

1. ACE Inhibitors(ex. ramipril, lisinopril)-interferes w production of angiotensin II-->vasodiliation-->reduced blood volume-->reduce afterload-->improve cardiac output-->improve renal flow-->reduce pulmonary congestion--> reduce peripheral edema
2. ARBs(ex. losartan, candesartan)-block action of angiotensin II-->same effect as ACE

Front 3

Medications to manage CHF

Back 3

3. diuretics(ex.furosemide, spironolactone)-inhibits reabsorption of sodium and water and promote excretion
4. Inotropic Agents(ex. digoxin)-improves myocardial contractility
5. Sympathomimetics(dopamine, dobutamine)-stimulate heart, improving force of contraction
6. Phosphodiesterase Inhibitors(ex. amrinone, milrinone)-increase myocardial contractility and cause vasodilation-->increase CO--> decrease afterload

Front 4

Nursing Implications: ACE

Back 4

-don't give to pregnant women
-careful w patient with blood volume depletion, or renal impairment
-monitor BP for 2hr following first dose, monitor weight daily
-monitor potassium levels, WBCs
-avoid making sudden position changes

Front 5

Nursing Implications: Diuretics

Back 5

-hypokalemia risk(except spironolactone)
-monitor BP, I&O, weight, edema
-monitor for volume depletion

Front 6

Nursing Implications: Inotropes

Back 6

-take apical pulse, if <60, withhold
-monitor for toxicity(anorexia, N/V, abd. pain, weakness, vision changes, blurred vision, yellow/green/white halos around objects)
-monitor potassium, magnesium, calcium, and digoxin levels
-administer digibind(digoxin immune fab) for toxicity

Front 7

Nursing Implications: Sympathomimetics/Phosphodiesterase

Back 7

-use infusion pumps to administer
-avoid abrupt d/c
-change solutions and tubing q24h
-monitor liver function/platelet counts(amnirone may cause hepatotoxicity and thrombocytopenia)

Front 8

Nursing Care for CHF

Back 8

-monitor vital signs
-pulse oximetry to monitor O2
-bedrest with HOB elevated
-monitor edema, daily weight, I&O
-do not give antidysrhythmics(most dysrhythmias are ventricular in nature, meds will cause ventricular depression-->CHF already has decreased ventricular function

Front 9

Pulmonary Edema

Back 9

-fluid moves from vascular and fills interstitial pulmonary and alveolar spaces
-MEDICAL EMERGENCY(death by suffocation)
-causes can be cardiac(MI, heart failure, valvular disease) or noncardiac(lung disorder, acute resp. distress, drug OD, sepsis)

Front 10

Signs and Symptoms of Pulmonary Edema

Back 10

cyanosis, gurgling, orthopnea, tachychardia, pink frothy sputum, feeling of doom, cool clammy skin
-ventricular gallop can be heard

Front 11

Treatment of Pulmonary Edema

Back 11

-sit upright, keep legs dependent(dangling)-->decreases venous return, decreases workload for heart by trapping fluid in the extremities
-drugs-->morphine, vasodilator
-O2 w/ positive pressure-->cpap or intubation
-diuretic-->lasix(furosemide) decreases venous return to heart
*ABCs first and when stable, find cause of edema

Front 12

Valvular Heart Disease

Back 12

interferes with blood flow to and from heart
-acquired valvular disorders stem from endocarditis, MI, rheumatic fever
*rheumatic heart disease is the most common cause

Front 13

Types of valvular heart disease

Back 13

1. mitral stenosis-narrowing of the mitral valve, obstructing blood flow from left atrium into left ventricle during diastole; usually caused by rheumatic heart disease or bacterial endocarditis; chronic and progressive
2. mitral regurgitation-allows blood to flow back into the left atrium during systole because valve doesn't close completely; rheumatic heart disease is most common cause
3. aortic stenosis-obstructs blood flow from left ventricle into the aorta during systole; may be idiopathic or congenital defect, or caused by rheumatic heart disease; degenerative changes associated to older adults

Front 14

Types of valvular heart disease

Back 14

4. aortic regurgitation-allows blood to flow back into the left ventricle from the aorta during diastole; most common cause is rheumatic heart disease; can be caused by endocarditis, chest trauma, syphilis, congenital
5. Tricuspid stenosis-obstructs blood flow from the right atrium to the right ventricle; usually caused by rheumatic heart disease and occurs concurrently with mitral stenosis
6. pulmonic stenosis-obstructs blood flow from the right ventricle into the pulmonary system; usually congenital, but may also be caused by rheumatic heart disease or cancer

Front 15

Symptoms of Mitral Stenosis/Complications

Back 15

-dyspnea on exertion is earliest sign, cough, hemoptysis, orthopnea, PND, weakness, fatigue, palpitations, frequent pulmonary infections
-complications:atrial dysrhythmias(a-fib due to atrial distention) and thrombi

Front 16

Symptoms of Mitral Regurgitation/Complications

Back 16

-click or murmur may be heard
-chest pain related to fatigue, not exertion
-tachydysrhythmias with lightheadedness and syncope
-complications: increases risk for bacterial endocarditis; can lead to heart failure, thrombi

Front 17

Symptoms of Aortic Stenosis/Complications

Back 17

-usually asymptomatic until disease has progressed(usually 50-70yrs)
-symptoms of left ventricular failure(dypsnea on exertion, angina pectoris, exertional syncope)
-harsh systolic murmur
-complication: pulmonary hypertension, right ventricular failure, sudden cardiac death

Front 18

Symptoms of Aortic Regurgitation

Back 18

-persistent palpitations, esp. while recumbent
-throbbing pulse in neck arteries
-Musset's sign(head bob)
-dizziness and exercise intolerance
-fatigue, exertional dypsnea, orthopnea, PND

Front 19

Symptoms of Tricuspid Stenosis

Back 19

-increased CVP, jugular distention, ascites, hepatomegaly, peripheral edema(similar to right-sided heart failure)

Front 20

Symptoms of Pulmonic stenosis

Back 20

-early signs are dypsnea on exertion and fatigue
-complication: right-sided heart failure with peripheral edema, ascites, hepatomegaly, increased CVP

Front 21

How is valvular heart disease diagnosed?

Back 21

-echocardiography
-cardiac catherization
-chest x-ray

Front 22

Treatment of valvular heart disease

Back 22

-anticoagulants with mechanical valves
-balloon valvuloplasty-used to correct a stenotic valve by straddling a balloon on the valve that is inserted through femoral vein or artery via cath lab
-surgery to replace or repair valve
-valve replacement surgery

Front 23

Pros and cons of mechanical valves

Back 23

benefit: longterm, durable
con: anticoagulant therapy for life

Front 24

Pros and cons of biological valves

Back 24

benefit: no need for anticoagulant therapy for life, easier to treat infection
con: less durable

Front 25

Rheumatic Heart Disease

Back 25

Systemic inflammatory process caused by the stretococcus bacteria that is characterized by:
-fever
-polyarthritis(5 joints or more)
-carditis
*most common cause for valvular heart disease

Front 26

Phases of Rheumatic Heart Disease

Back 26

-pt suffers an acute streptococcal infection(usually 5-15 years old)
-pt recovers and is symptom free for 1-5 weeks
-Rheumatic symptoms begin

Front 27

Nursing care for Rheumatic fever in prevention of Rheumatic Heart Disease

Back 27

-treat strep throat infections early
-complete administration of full dose antibiotics
-with pts w/ preexisting heart condition, use of prophylactic antibiotics prior to invasive procedures to prevent infective endocarditis

Front 28

Vegetation in endocarditis

Back 28

abnormal growth of tissue
-proteins
-clotting factors
-bacteria
-platelets

Front 29

Symptoms of rheumatic heart disease

Back 29

-red swollen joints
-subcutaneous nodules
-cardiac symptoms(chest pains, heart murmurs)
-thickened red synovial membranes
-jerky involuntary movements, irritability