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107 Cards in this Set
- Front
- Back
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what is a PTCA
2 |
intervention with a
catheter and a balloon tip which is inflated to compress non-calcified soft) plaque |
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what is necessary to have
when doing a PTCA 2 |
OR on standby
blood vessel can burst from compression of plaque and lead to bleeding in pericardial sac |
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what are the advantages
of a PTCA 2 |
alternative to open
heart surgery local anesthesia no thorcotomy ambulate 24 hrs LOS 1-3 days vs 5-7 w/ CABG return to work 1 wk |
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what are the complications
of PTCA 2 |
rupture artery
infarction from plaque breaking off (MI) (important to note if pt presents with chest pain after procedure) closure from thrombus |
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what can also be done with a
PTCA 2 |
stent placement to hold vessel open
can be drug eluting stent on integralin after cath lab for 16 hrs to prevent clots from adhering to stent |
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what are nursing considerations
post procedure for PTCA 2 |
assess for bleeding
pt will be on anticoagulants (ASA, Plavix) for 3 months takes 3 months for tissue to grow around metal stent after 3 months stay on ASA (daily cardiac med) and off Plavix |
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what is an athrectomy
2 |
used for calcified (hard)
plaque plaque is shaved off wall and suctioned out of blood vessel |
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what is a potential complication
from a athrectomy 2 |
infarct in blood vessel from
plaque breaking off |
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what is an intraaortic balloon
pump 2 |
sausage shaped ballon
placed in aorta time to inflate and deflate in synch with cardiac cycle to increase perfusion of coronary arteries |
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what does an intra-aortic
balloon pump do 2 |
decreases cardiac work load for short term
reduces afterload reduces left ventricular diastolic pressure |
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what are the complications of
IABP 2 |
arterial trauma or hemmorrhage
(pts foot tried to bed with restraint for medical safety so balloon does not stop and develops clots and can lead to thromboembolism pneumonia from immobility site infection |
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what pts are more likely to
get cardiogenic shock 2 |
pts with blocked LAD which
feeds the left venticle which is the main pump for the body delivering 70% of cardiac output |
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what is the highest priority for
IABP 2 |
coronary arteries, they are
perfused first and then the IABP lets the blood go to the rest of the body |
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what are the time frames for interventions
2 |
IABP short term use
VAD long term use but still temporary |
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what is the function of
an IABP 2 |
does work for heart so
heart can recooperate, perfuses all organs and heart better |
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what is an circulatory assist
device 2 |
left ventricular assist device
which replaces the action of the left ventricle internal or external blood shunted from left atrium to the aorta |
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who is good candidate for
a IABP 2 |
a pt who has had a MI that
knocks out the left ventricle and they go into cardiogenic shock |
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who are good candidates
for LVAD 2 |
pt who fail to wean from
the cardiopulmonary bypass after surgery waiting for heart transplant-bridge to transplant can be bi-ventricular |
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what is coronary artery
revascularization 2 |
open heart surgery-CABG
(coronary artery bypass grafting) veins or arteries from other areas of body are used as pathways around obstructions to improve blood flow to heart long recover |
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which arteries can be used
2 |
radial artery-preferred
last 20 yrs saphenous vein mammary vein-no need to have another surgical site to harvest vein |
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what are other types of
coronary revasculization that are not as invasive 2 |
minimally invasive CABG
transmyocardial revascularization TMR |
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what inidicates sucessful
reperfusion of the heart after use of a thrombolytic 2 |
ST segment returns to normal
Chest pain stops |
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what are medications used for
acute coronary syndrome 2 |
Plavix antiplatelet
ASA-daily antiplatelet MS04-(morphine) pain dilates coronary arteries amiodarone antidysrhythmia stool softeners- no valsalva maneuver anticoagulants long term -warfarin (coumadin) anti-lipemics-statins |
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why are stool softners used
for cardiac pts 2 |
to prevent valsalva maneuvers
thru staining increases pressure in chest cavity that leads to decreased blood flow and bradycardia, cardiac arrest can cause bradycardia by impairing blood flow to the heart |
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what are the time frames for anticoagulants
2 |
heparin-short term in hospital
warfarin-long term can be on at home |
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what are HMG-CoA reductase
inhibitors 2 |
statin drugs
anti-lipemics stop cholesterol synthesis in liver by inhibiting HMG-Coa reductase |
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what are some examples of statins
2 |
atorvastatin-lipitor
lovastatin-mevacor simvastatin-zocor |
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what are adverse effects
associated with statins 2 |
rhabdomyolysis-pt to report muscle tenderness
-lead to kidney failure elevated liver enzymes -monitor liver enzymes |
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how is coumadin monitored
at home 2 |
PT prothrombin time
10-13 secs produced by the liver and dependent on vitamin K INR international normalized ratio 2.0-3.0 |
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what are antagonist of coumadin and heparin
2 |
heparin-protamine sulfate
coumadin vitamin k |
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how do you manage angina
summary 2 |
give O2-feeds muscle
dilate coronary arteries-nitroglycerin decrease workload heart- beta blockers calcuim channel blockers widen vessel angioplasty w/ stent thrombolytics avoid anemia-monitor cbc avoid alterations gas exchange-rest |
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what is drug of choice to dilate coronary arteries
2 |
nitroglycerin
morphine also dilates coronary arteries but is not the drug of choice, often given with nitro |
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what is nursing care for angina
2 |
assess and reassess pain
baseline VS=pulse ox monitor I and O=perfusion to kidney telemetry=dysrhythmiias daily wts-CHF DVT assessment-on bedrest trust-you will come |
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what 3 things go down with
decreased cardiac output 2 |
blood pressure( HR goes up
to compensate for lower blood pressure) urine output level of consciousness LOC |
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what do the VS do immediately after angina
2 |
blood pressure increased due to anxiety (release of catecholamines) then blood pressures drops because cardiac output drops
heart rate increases to try to compensate for low blood pressure |
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what level should pain be at in angina or MI pt
2 |
pain should at zero=no ischemia, muscle being oxygenated
assess and reassess constantly |
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what type of O2 should pts be
given if amount over 2 L 2 |
humidified O2
to prevent dryness of mucous membranes and nose bleeds |
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what nursing considerations should be addressed with cardiac pt
2 |
anti-depressant-psych consult
risk factors-modifiable clear information support system role identity AHA materials |
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what education issues should be addressed to cardiac pt
2 |
modifiable risk
nutrition-low fat and cholesterol IBW control HTN S/S angina chest pain sob quit smoking space activites education nitrates exercise program sexual counseling |
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what vital sign does nitroglycerin
effect 2 |
blood pressure
dilates coronary arteries -blood pressure drops does not effect heart rate |
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what is CHF
2 |
not a disease
inability of heart to pump blood to met needs of body forward flow of blood into heart=backs up =failure |
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what is flow of blood in heart
2 |
enters inferior and superior vena cava
right atrium tricuspid valve right ventricle pulmonary arteries lungs pulmonary veins left atrium mitral valve left ventricle aorta coronary arteries |
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what are causes of CHF
2 |
CAD
hypertensive heart disease valvular problems MI arrhythmias rheumatic heart disease anemia bacterial endocarditis |
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what are the four
compensation mechanisms that effect cardiac output 2 |
HR increases
contractility increases afterload increase (vasoconstriction) to raise blood pressure preload increase (puts more blood in heart) |
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what system aggravates CHF
2 |
RAAS
renin angiotensin-aldosterone system creates negative loop low bp-low renal perfusion-activate RAAS constricts vessels and makes worst |
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what is the drug of choice for CHF
2 |
ace inhibitor
to stop the RAAS opens aorta so heart does not have to pump harder |
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what system gets turned on
with decreased blood pressure leading to decreased renal perfusion to kidney 2 |
RASS
renin-angiotensin-aldosterone system constricts blood vessels including aorta |
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what causes remodeling in CHF
2 |
heart enlarges to try to compensate for
low cardiac output |
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what is systolic (left) HF
2 |
inability of heart to contract effectively
EF less than 35-40% (decrease CO) normal EF 70% |
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what is diastolic HF
2 |
ventricles don't relax and fill
can contract effectively good EF |
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what are the classification of HF
2 |
I-no limitation
II-DOE III-marked limitation IV-symptomatic at rest |
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what are risk factors for CHF
2 |
CAD
HTN age DM smoking-vasocontriction obesity-work harder high serum cholesterol |
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what is cardiac output CO
2 |
amt of blood ejected per minute
SVxHR 4-8L/min |
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what is cardiac index CI
2 |
CO divided by body surface
area BSA more accurate considers size of the body 2.5-4L/min |
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what is CVP
2 |
pressure in rt atruim
to tell the pressure of the right ventricle (how is ventricle pumping) 2-8-mmHg 12=more fluid/high pressure (lasix, less IV fluids) 1=less fluid/low pressure (ie dehydration) |
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what is preload
2 |
volume of blood in ventricle after diastole
(filling)/relaxation stretching LVEDP measured as PCWP |
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what is afterload
2 |
amt of resistance ventricles have to overcome to
eject stroke volume higher pressure means more work to push against pressure 800-1200 dynes/sec/cm SVR=MAP-CVP/COx80 |
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what are the S/S of left HF
2 |
dyspnea
orthopnea dry hacking cough nocturia-kidney perfuses at night increased HR-compensates PMI displaced inferiorly-mitral valve decreased PaO2 increased PaCO2 crackles/rales in bases and rises (ask sob and give more lasix) S3 and S4 heart sounds |
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what is pulmonary edema
2 |
blood-left ventricle-left atrium
-pulmonary veins alveoli saturated with blood, no gas exchange life threatening may need to be intubated give IV lasix |
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what are the sign and symptoms of right HF
2 |
peripheral and dependent edema
anorexia and GI bloating and nausea heart murmur wt gain/anasarca JVD-45 degree hepatomegaly R pleural effusion |
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what is the first diagnostic assessment
done for CHF right or left 2 |
listen to lungs
bibasilar crackles in bases of lungs if crackles start to go up lungs = worsening condition |
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what are dx studies for CHG
2 |
physical exam-listen for rales
CXR-enlarged heart 12 lead ECG-dysrhythmia hemodynamic assessment-measure pressures in heart echocardiogram-see structure ABG analysis-tell how breathing and oxygenating BMP or creatinine-see if perfusing kidney |
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what is cardiomyopathy
2 |
heart muscle disease of unknown cause
bad prognosis, may need heart transplant |
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how is diagnosis for
cardiomyopathy made 2 |
presents like CHF
when treatments used in CHF do not work then dx is made for cardiomyopathy ie lasix |
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what are the causes of primary and secondary cardiomyopathy
2 |
primary- virus or idiopathic
secondary-alcoholism pregnancy underlying disease |
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what are the psychosocial
aspects of CHF 2 |
pt fearful of death
anxious about exacerbations frustration leads to higher non-compliance |
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what is the second drug of choice for CHF
2 |
digoxin
postive inotrope improves contractility negative chronotrope slows down improves cardiac output decreases HR need to monitor serum levels |
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what is important to teach pt
taking digoxin 2 |
teach pt to count pulse
before taking drug call physician if under 60 bpm S/S toxicity |
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what are the S/S of digoxin toxicity
2 |
N/V
bradycardia blurred vision yellow halos |
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what increases the risk of digoxin toxicity
2 |
hypokalemia
serum level of potassium 3.5-5.0 serum levels with digoxin need to be 4.0 or greater |
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what is the third drug important for CHF
2 |
lasix a diuretic
need to watch potassium level take in morning to decrease nocturia IV acute po maintenance |
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what foods are high in potassium
2 |
bananas
oranges potatoes apricots tomatoes |
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what is the 4th drug for CHF
2 |
the beta blocker of choice
is Carvedilol/Coreg decreases workload of heart |
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what is important teaching
for carvedilol 2 |
monitor pulse and BP
watch for orthostatic hypotension abrupt withdrawal leads to dysrhythmias HTN MI |
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what is nursing care in CHF
2 |
full fowlers position
rest fluid restriction strict I and O monitor electrolytes esp K daily weights prevent complication of immobility correct hypoxemia |
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what is the best way to know fluid status
2 |
daily weight
same time |
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what symptoms should pt call physician for
2 |
weight gain of 5# in a week
weight gain of 2# in 24 hrs SOB shoes getting tight decreased urination |
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what are the four drugs that are
the drug of choice for CHF 2 |
Ace Inhibitors-lisinopril, analapril
Digoxin Lasix Beta blocker-Coreg-carvedilol |
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what risk for is increased in CHF
with digoxin and a beta blocker 2 |
increase risk of bradycardia
|
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what three drugs for CHF can cause
postural hypotension 2 |
ace inhibitor
beta blocker digoxina |
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what is important diet teaching
2 |
soduim restriction
no table salt 500-1000 mg mild 2.5 mg no high salt foods loss wt daily wt read labels |
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what is infective endocarditis
2 |
infection of the
endocardial inner layer of the heart bacteria flows thru heart and get stuck on valves |
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what are some causes
of infective endocarditis 2 |
bacteria from
staph then strept invasive procedures surgical interventions IV drug use-60% of pts-inject drugs into vein, come into right side heart on tricuspid valve |
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how is presentation of
infective endocarditis 2 |
presents like CHF
defective valve causes backward flow of blood |
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what is one diagnositic tool that can look directly at the valve
2 |
echocardiogram
shows structure of heart can see what is on valve |
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what is a serious complication
of infective endocarditis 2 |
possible embolization
piece of vegetation can break off rt side(tricuspid) =pulmonary embolism lf side (mitral) =brain |
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what are the diagnostic studies
2 |
ESR-inflammation
WBC-infection echocardiogram CXR |
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what is the treatment for
infective endocarditis 2 |
IV abx for 4-6 wks
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what is nursing care for
infective endocarditis 2 |
obtain cultures 1st-before treatment
abx-broad spectrum complication-CHF at risk populations IV drug use pts getting procedures |
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what are the clinical manifestations
of infective endocarditis that lead to diagnosis 2 |
flu like-SOB, fever,chills
arthralgias splinter hemorrhage nail beds petechiae-micro embolism osler nodes-finger tips or toes pea shaped janeway lesions-palms and soles flat and red roth spots on retina new onset murmur incompetent valve leads to CHF |
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what significant problem does infective endocarditits lead to
2 |
CHF due to incompetent valves
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why are two cultures drawn
for infective endocarditis 2 |
in case on sample was infected
with staph from the skin |
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what is collaborative care for
infective endocarditis 2 |
IV abx
ASA joint pain corticosteriods for inflammation valve replacement surgery ? |
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what is nursing care for infective endocarditis
2 |
blood cultures first to id organism
abx therapy-broad then specific tylenol fever prevent complications of immobility assess for complication-CHF id at risk population |
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what is important teaching
for infective endocarditis 2 |
prevention
good oral care abx prophylaxis prior to procedure early treatment for infections |
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what is a bruit
2 |
turbulent blood flow thru a blood vessel
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what is a murmur
2 |
turbulent blood flow thru a valve
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what is acute pericarditis
2 |
inflammation of the pericardial sac
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what causes acute pericarditits
2 |
idiopathic
infectious viral coxsackievirus B dresslers syndrome after acute MI uremia-renal failure trauma neoplasm |
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what is the clinical manifestation
of acute pericarditis 2 |
inflammatory chest pain relived by sitting up
and forward dyspnea-hurts to breath pericardial friction rub increased WBC elevated ST segments (looks like MI) and T waves |
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what are the complications of
acute pericarditis 2 |
pericardial effusion-rapid accumulation of excess
pericardial fluid, but slower in renal pts cardiac tamponade-fluid accumulation in pericardial sac which compresses heart pumping ability emergency |
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how is pericardial effusion fixed
2 |
since venous blood it can be drained
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how is cardiac tamponade fixed
2 |
arterial bleed, bleed fast and squeezes heart
heart will sound muffled drain blood with a needle |
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what are diagnositic test for
acute pericarditis 2 |
EKG-will see ST segment changes
do serial to see return to baseline echocardiogram to see how much fluid CXR-enlargement of heart |
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what is collaborative care for
acute pericarditis 2 |
rest
abx steroid/NSAIDS-decrease inflammation pericardiocentesis-OR drain with chest tube for renal pts pericardial window (slit so fluid will drain out) when SBP drops 30 pts |
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what is nursing care for
acute pericarditis 2 |
differentiate from cardiac pain
sit up and lean forward serial EKG to watch ST segment bed rest, HOB 45o antiflammatory observe for signs of decreased CO decrease BP, UO, LOC |
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what is nursing education in
acute pericarditis 2 |
not dring while on meds
simple explanation infor about meds ie steroids have to be weaned off NSAIDS-do not take ASA too can cause bleeding |
