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79 Cards in this Set
- Front
- Back
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Diuretic therapy can cause what |
hypokalemia |
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What type of loop diuretic |
Furosemide |
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What are some cardiac effects of K+ hypokalemia |
increased risk of digoxin toxicity ventricular dysrhythmias flattening and inversions of T wave presence of U wave cardiac arrest |
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Hyperkalemia us usually related to |
renal dysfunction excess K+ supp |
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what are some cardiac effects of hyperkalemia |
ventricular dysrhythmias tall peaked T waves on ECG asystole |
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In older adult what happens to cardiac valves |
calcification mucoid degeneration mainly mitral and aortic valve
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In older adult what happens with the conduction system |
Pacemaker cells decrease in number fibrous tissue and fat increase SA node few muscle fibers remain in the atrial myocardium and bundle of his conduction time increase |
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In older adult what happens left ventricle |
increases in size stiff and less distensible diastolic filling decrease by 50% |
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In older adult what happens aorta and other Lg arteries |
thicken stiffen less distensible systolic BP increases to compensate for stiff arteries systemic vascular resistance increases hypertropy |
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In older adults what happens to barorecptors |
less sensitive
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Nursing interventions cardiac valves |
assess HR rhythm Hears sounds Question about dyspnea |
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Nursing interventions conduction system |
HR < 60 ECG for dysrhythmias
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Nursing interventions left ventricle |
ECG for widening QRS complex longer QT interval |
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Nursing interventions aorta and other Lg arteries |
BP Not increase in systolic, diastolic, and pulse pressure activity intolerance SOB peripheral pulses |
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Nursing interventions baroreceptors |
BP standing, lying and sitting dizziness? when change position Teach to change position slowly |
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Rationales cardiac valves what are you looking for |
Murmurs rhythm changes |
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Rationales conduction system what are you looking for |
SA node lose it inherent rhythm Atrial dysrhythmias |
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80% of older adults experience what conduction system malfunction |
PVC's premature ventricular contractions |
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Ventricular changes result in decreased what in the left ventrical |
decreased stroke volume ejection fraction CO during exercise less able to meet increased O2 of heart |
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Rationales what happens in the aorta and arteries |
HTN |
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Rationales Baroreceptors have to do with |
orthostatic |
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What are some cardiac markers |
troponin creatine kinase myoglobin |
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Is a myocardial muscle protein released into the bloodstream with injury to myocardial muscle |
troponin |
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MI is also known as |
acute coronary syndrome |
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is an enzyme specific to cells of the brain, myocardium, and skeletal muscle |
creatin kinase CK |
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what does CK in the blood mean |
tissue necrosis or injury |
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Earliest marker detected - maybe 2 hrs after MI |
Myoglobin |
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Which cardiovascular assessment lab checks for CAD |
Serum Lipids |
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an amino acid that is produced when proteins break down |
homocysteine |
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What are some serum lipids that check for CAD |
HDL LDL triglyceride total cholesterol |
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Highly sensitive C-reaction protein hsCRP
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Most studied marker of inflammation |
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PT |
checks anticoagulants Warfarin coumadin |
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PTT |
Heparin |
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is inability of heart to pump adequate blood to meet metabolic needs of body |
HF |
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What cause HF |
myocardial damage from MI incompetent valves inflammatory cond. of heart cardiomyopathy pulmonary HTN (cor pulmonale)
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What happens in the compensatory phase of HF |
1. CO falls a. sensed by baroreceptors b. stimulate SNS 2. release of epinephrine and norepinephrine 3. increase in HR and vasoconstriction 4. increased in filing pressures 5. increase in SV and CO |
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Compensatory mechanisms increase cardiac metabolic demands and in time? |
decrease cardiac function and ability to compensate |
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Where does Right sided HF back up to |
venous circulation body |
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where does left sided HF back up into |
pulmonary circulation lungs |
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What happens to the body in acute HF with overload in lungs |
pulmonary edema restlessness anxiety increased crackles tachypnea tachycardia pink frothy sputum decreased SO2 and PO2 |
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Assessment S/S of HF left |
dyspnea on exertion (often 1st sign) orthopnea paroxysmal nocturnal dyspnea new S3 (ventricular gallop) crackles pulmonary edema (acute life threat) angina weakness
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Assessment S/S of HF right |
edema lower extremities JVD nausea (fluid congestion in abdominal organs) abdominal discomfort weight gain |
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Assessment S/S of HF both sides |
unexplained fatigue decreased exercise tolerance AMS |
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What are labs for HF |
chest x ray ECG CVP elevated in right HF PA pressure monitoring |
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Priority nursing for HF what might happen |
reduced CO fluid overload alteration in gas exchange inability to tolerate activity inadequate knowledge |
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Planning and implementation HF acute phase |
Monitor BP, pulse, respiration, ECG, and CVP to detect changes in the CO Pt in sitting position to decrease pulmonary congestion Lung auscultation Give O2 Give meds monitor serum electrolytes to detect hypokalemia I&O
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Planning and implementation HF chronic phase |
Get a baseline assessment for fluid staus monitor daily weight assess the fluid status - regular intervals |
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What kinds of Meds do you give HF |
1. angiotensin converting enzyme ACE 2. ARB's angiotensin II receptor blockers 3. Diuretics ie loop diuretics (furosemide - Lasix) 4. Vasodilators 5. Morphine 6. Digoxin (lanoxine) 7. Dopamin |
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What do ACE do for HF? |
reduce afterload increase CO |
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ACE monitor for |
hypotension orthostatic (especially)
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ARB's do for HF |
interrupt vasoconstrictor and aldosterone secreting effects of angiotensin II |
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Diuretics do for HF |
decrease preload and pulmonary congestion
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What happens when you decrease pulmonary congestion |
decreases cardiac work increases CO |
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Vasodilators what do for HF example of drug monitor for |
nitroglycerine reduce preload monitor hypotension |
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Morphine do for HF monitor for? |
sedate vasodilate decreases cardiac workload monitor for hypotension and respiratory depression |
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Digoxin (lanoxin) do for HF what do you do before you give this drug |
improve contractility increase SV and CO apical pulse for 1 min slow conduction through AV node |
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What drug is used in critical care of HF |
dopamine (Intorpin) when decompensation of CO leads to hypotension monitor BP and IV site frequently |
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Pt in acute HF should not be started on these drugs |
Beta blockers |
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What beta blockers are approved for chronic HF |
metoprolol bisoprolol carvedilol |
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Defects in cardiac valve structure of function that interfere with proper cardiac circulation |
Valvular disorders |
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What are the 2 main valvular disorders |
stenosis regurgitation |
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heart valve leaflets are fused tighter, opening is narrow, stuff, and unable to open or close properly |
stenosis |
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incomplete closure of the heart valve, resulting in backflow of blood |
regurgitation |
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Priority nursing problems what can go wrong |
reduced cardiac output potential for thrombus formation or infection inadequate knowledge can't do exercise or activities |
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What are some planning and implementation for valvular disorders |
monitor heart sounds signs of decreased CO, restrict activity monitor for signs of endocarditits |
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Medication therapy Valvular disorders What are some things you might have to treat |
Antibiotic for endocarditis Antidysrhythmic and anticoagulant for A-fib |
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What do you need to monitor lab wise Valvular disorders |
PT/INR Why - warfarin |
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What Vit do you want to maintain with Valvular disorders |
Vit K green leafy vegetables |
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What are the expected outcomes for Valvular disorders |
no signs of endocarditis describes s/s to report to MD optimal level of function |
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inflammation of inner layer of heart, usually involves cardiac valves |
endocarditis |
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Caused by staphylococcus aureus |
acute endocarditis |
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Caused by streptococcus viridans |
subacute endocarditis |
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Acute endocarditis s/s |
high fever with chills signs of HF WBC elevation |
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Subacute endocarditis s/s |
High fever unknown origin cough dyspnea anorexia malaise normal WBC anemia elevated ESR erythrocyte sedimentation |
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Priority nursing what can go wrong be prepared |
potential for injury related to thrombus formation inadequate knowledge related to prevention of repeated infection |
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Planning and implementation what do you need to do as a nurse |
s/s of infection anti embolism stockings
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What symptoms do endocarditis need to report to MD |
fever anorexia malaise |
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What is the most common complication of infective endocarditis |
HF |
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