2.2 Cardiovascular, Shock, Complications CHD Flashcards
Describe cause, assessment findings, medical treatment and nursing interventions for
VALVULAR DISORDER
Valvular disorders:
S/S: Mostly left side of heart Decreased EF Decreased cardiac output Syncope SOB Pulmonary edema Arrhythmias, A-fib EKG changes
Transcatheter Aortic Valve Replacement (TAVR):
Placed directly over the native diseased valve
Uses femoral artery or axillary/subclavian
Monitor for vascular complications post op
Arrhythmia
Stroke
Mechanical replacement:
Need anticoagulation for life
Can hear audible “click” of closure of valve
Porcine/Bovine replacement:
Describe cause, assessment findings, medical treatment and nursing interventions for
HYPERTENSIVE CRISIS
Hypertensive Crisis:
Systolic >180
Diastolic >120
Urgency clinical presentation:
Most often a non adherent pt
Usually asymptomatic, some report mild cephalgia (HA)
Very manageable with oral meds as out pt
Presentation: Neuro: encephalopathy (dizzy, severe HA, lethargic, confusion, seizures) Heart: angina/AMI Pulmonary edema Kidneys: AKI, azotemic (elevation of blood urea nitrogen (BUN) and serum creatinine levels) Back pain: poss aortic dissection N/V Pregnant pt- eclampsia
TX:
Treat MAP
Nitroprrusside, NTG, Cardene, Labetalol
Nursing: Monitor BP/MAP, treat per orders Assess neuros: LOC, visual/speech changes Monitor chest pain, EKG Monitor urinary output Monitor/report abnormal labs
Describe cause, assessment findings, medical treatment and nursing interventions for
AORTIC ANEURYSM
Aortic Aneurysm:
Abnormal dilation of a blood vessel, commonly at a site of weakness or a tear in the vessel wall.
Destruction of elastin can lead to abnormal dilation of vessel and collagen destruction can allow the vessels to rupture.
Location: anywhere along the aorta, most often just below renal arteries but above ileac bifurcation
Etiology:
Arteriosclerosis compounded by HTN
Appearance:
Fusiform: spindle shaped
Saccular: unilateral outpouching
Dissecting: split or tear in intimal surface with bleeding into newly formed cavity between the vessel layers
Nursing care: Surgical pt Neuro status Cardiac monitoring Gastro/hepatic Renal Peripheral perfusion
Describe cause, assessment findings, medical treatment and nursing interventions for
ACUTE ARTERIAL OCCUSION
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Describe cause, assessment findings, medical treatment and nursing interventions for
DIC
Disseminated Intravascular Coagulation (DIC):
Clotting disorder secondary to overwhelming disease process/pathology
Clotting occurring in some places, bleeding occurring in other
Sepsis is most common cause of DIC
DIC is triggered by endothelial damage, release of tissue factors into the circulation or inappropriate activation of the clotting cascade by an endotoxin. Both intrinsic and extrinsic (usually one that is activated) clotting cascade may be activated.
Presentation:
Thrombi of microcirculation: capillaries, caused stasis of blood, metabolic acidosis, aggregation of clotting factors.
Leads to ischemia, necrosis, multiple organ failure
Onset:
Dramatic
Bleeding from any site: clotting factors used up
Platelet drop <140k
Prolonged PT >15 sec
Decreased fibrinogen, measured as thrombin
Increased FDP/FSP
Manifestations: Frank hemorrhage from incisions Oozing blood from punctures, intravenous catheter sites Purpura, petechiae, bruising Cyanosis on extremities GI bleed/hemorrhage Dyspnea, tachypnea, bloody sputum Tachycardia, hypotension Hematuria, oliguria, acute renal failure
Diagnostic:
Platelet; early indication <140k. Prolonged PT >15 sec. High PTT >35 sec
Stimulation of fibrinolysis; decreased fibrinogen, used up making clots. increased FSP, fibrin split products from breaking down clots
D-dimer; shows degree of fibrinolysis
Treatment: Treat underlying cause Heparin IV Replace clotting factors, platelets, FFP, cryoprecipitate Replace RBC Vit K Treat liver disease if present AT III, Antithrombin III
Describe cause, assessment findings, medical treatment and nursing interventions for
PULMONARY EMBOLISM
Pulmonary embolism:
Obstruction of blood flow in a part of the pulmonary vascular system by an embolus
thromboembolic or clot develop in venous system or right side of heart are most common
Predisposing factors: History of DVT Prolonged immobility Trauma including hip/femur fractures MI HF Obesity Age Oral contraceptive or estrogen
Manifestations:
Depends on size and location of emboli
May be asymptomatic
Manifestations usually develop abruptly (minutes)
S/S: Dyspnea SOB Pleuritic chest pain Anxiety, impending doom Diaphoresis Hypoxia Anxious Hemoptysis Syncope Cyanosis Tachycardia Tachypnea Crackles/gallop Fever, low grade
Diagnosis: ABG's EKG, T inversion D-dimer V/Q scan CT
NI: Tele Relieve hypoxia Thrombolytics Heparin IV per protocol Anticoagulants Intra-caval filter Greenfield) Thrombectomy if unstable
Prevention: Ambulation Teach how to admin SQ med Elevate legs Adequate hydration Anti-embolic stockings/IPC's Avoid venipuncture of lower extremities Teach about Vit K
Describe cause, clinical presentation, lab tests, medical treatment, nursing responsibilities for
HYPOVOLEMIC
Hypovolemic:
Most common type
Intravascular volume loss
Need replacement immediately
Crystalloid (lactated ringers, NS) then Colloids if LR or NS does not work, (Albumin, protein source)
Example: Blood loss from surgery Fluid loss from diarrhea DKA Burns
Describe cause, clinical presentation, lab tests, medical treatment, nursing responsibilities for
CARDIOGENIC
Cardiogenic:
Heart can not pump enough to perfuse cells
Causes: AMI with loss of myocardium MR/AS Ventricular/septal rupture Cardiac tamponade Toxic meds
BP: hypotension, pos. narrowing pulse pressures
Pulse: rapid, thready, distention of veins in hands/neck
Resp: increased, labored, crackles, wheezes, pulmonary edema
Skin: pale, cyanotic, cold, moist
Mental: restless, anxious, lethargic progressing to comatose
Urine output: oliguria to anuria
Other: dependent edema, elevated CVP and pulmonary cap wedge pressure, arrhythmias
Medical management:
Improve cardiac contractility and BP
IABP, Impella
Tamponade: drain pericardial sac
Nursing:
Note patient response to medical and NI, HOB up, frequent assessment of lung sounds, urine output, VS within established parameters )map, co, cvp, pcwp)
Describe cause, clinical presentation, lab tests, medical treatment, nursing responsibilities for
SEPTIC/TOXIC SHOCK
Septic/toxic shock:
Life threatening organ dysfunction caused by dysregulated host response to infection
Mental: altered
BP: hypotensive
Resp: increased
Causes:
Toxins affect vessels resulting in vasodilation and capillary leakage
Presentation:
Initially: increased temp, decreased BP
Later: decreased temp, diaphoresis, anuric, decrease LOC
Med tx: Fluid replacement, 30mg/kg isotonic solutions Empiric IV antibiotics after cultures CVP 8 Vasopressors?
NI:
Monitor and implement plan related to pt VS (MAP)
Urine output 0.5ml/kg
Pt safety
Describe cause, clinical presentation, lab tests, medical treatment, nursing responsibilities for
ANAPHYLACTIC
Anaphylactic/Distributive Shock:
Direct effect of histamine on vessels
Clinically:
BP: hypotension
Pules: increased, dysrhythmias
Resp: dyspnea, stridor, wheezes, laryngospasm, bronchospasm, pulmonary edema
Skin: warm, edematous (lips, eyelids, tongue, hands/feet, genitals)
Mental: restless, anxious, lethargic to comatose
Urine output: oliguria to anuria
Other: Paresthesias, urticaria, pruritis, ab cramps, vomiting, diarrhea
Circulation collapse
Medical management: Antihistamine; Epinephrine; Airway; Educate;
Medications used to treat shock
Shock medications:
Blood components and crystalloids- replaces intravascular volume
Inotropic and vasopressive- increase cardiac output and improve tissue perfusion
Opioids- pain relief
Immunizations- if penetrating/open wounds
Discuss the IABP including rational for its uses and nursing interventions
An intra-aortic balloon pump (IABP), typically placed in the left ventricle:
Used after cardiac surgery or to treat cardiogenic shock following AMI.
Temporary support cardiac function allowing the heart to gradually recover by decreasing myocardial workload and O2 demand and increasing profusion of coronary arteries
Attached to the tip of the catheter is a long balloon, inserted via femoral artery.
Catheter inflates during diastole, increasing perfusion and deflates just prior to systole, decreasing afterload and cardiac workload. Triggered by ECG patterns
Interventions: Manage acute pain Relieve chest pain Reduce cardiac work Promoting oxygenation Psychosocial support
Hypovolemic shock stages
Hypovolemic shock stages:
Stage 1 (early, reversible): Baro-receptors respond to reduced volume with sympathetic stimulation and peripheral constriction.
BP: norm-slightly elevated Pulse: slightly increased Resp: norm Skin: cool, pale (periphery), moist Mental: alert/oriented Urine output: slight decrease Other: thirst, decrease cap refill time
Chemo-receptors respond to decreased pH, buildup of lactic acid
Juxtaglomerular receptors respond to decreased blood flow with RAAS response
Osmo-receptors, increase osmol and increased ADH release
Stage 2 (immediate or progressive):
Electrolyte imbalances
Metabolic/resp acidosis
BP: hypotensive
Pulse: rapid, thready
Resp: increased
Skin: cool, pale (including trunk), poor turgor with fluid loss, edema with fluid shift
Mental: restless, anxious, confused, agitated
Urine output: oliguria
Other: marked thirst, acidosis, hyperkalemia, decreased cap refill, decreased/absent peripheral pulses
cardiac ischemia Hypotension; ileus, ATN/AKI, transaminitis/ischemic hepatitis Cool skin/pallor Confused/encephalopathic Lactic acid level increase
Stage 3 (refractory or irreversible):
Tissue anoxia
Cell death
BP: severe hypotension (systolic below 80)
Pulse: very rapid, weak
Resp: rapid, shallow, crackles, wheezes
Skin: cool, pale, mottled with cyanosis
Mental: disoriented, lethargic, comatose
Urine output: anuria
Other: loss of reflexes, decreased/absent peripheral pulses
Flow to organs decreases as vasoconstricting medication is added
Obstructive Shock
Obstructive Shock:
Obstruction in the heart or vessels
Causes: impaired diastolic filling
Pericardial tamponade
Tension pneumothorax
Increased right and left ventricle overload
Distributive Shock
Distributive shock (aka vasogenic shock): Include several types of shock that result from widespread vasodilation and decreased peripheral resistance Blood volume does not change, relative to hypovolemia results.
Examples:
Septic
Neurogenic
Anaphylactic
