Aeration/Circulation: Cardiac Flashcards
Stenosis
- Narrowed (valve doesn’t open completely)
- Forward blow hindered
- Decreased cardiac output
Regurgitation
Valve doesn’t close completely
Mitral Valve Prolapse- MVP
What is it?
- During ventricular systole, mitral valve flaps normally close
- In MVP, one/both flaps bulge into left atrium
- If bulging flaps do not fit together, mitral regurgitation occurs
- Unknown etiology
MVP S&S
Often none CP Dyrythmias Dyspnea Fatigue Palpitation
MVP complications
Dilation of L side of heart
HF
Infective endocarditis
Emboli
MVP NI’s
None, unless symptoms are present Healthy lifestyle Avoid stimulants/caffeine Stress management Beta blockers for tachycardia Valve surgery
Cardiac cvalvular surgery (2 types)
Minimally invasive:
- endoscopy
- Robotic
Traditional
-open cardiac surgery with cardiopulmonary bypass
Stenosed valve reapirs
- Balloon valvotomy
- Commissurotomy
Insufficient valve repair
-Annuloplasty
Heart valve replacement: Mechanical
- Durable
- Creates turbulent blood flow (lifelong anticoagulation)
- Used for younger adults usually
Complications of mechanical heart valve replacement
INR/PT montioring
Thrombus/Embolism formation
Anemia
Endocarditis
Heart valve replacement: Biological
- Porcine (pig)
- Bovine (cow)
- Allografts (human)
- Autograft
- Not as durable as mechanical
- Used for older adults usually
- No lifelong anticoagulation needed
- **Has cultural considerations
Biological heart valve replacement complications
Degenerative changes
Calcification
Cardiac surgery prep: Assesment
- Circulatory status
- Pain control needs
- Diagnostic tests
- Typing and cross-matching of blood needed
Cardiac surgery prep: Teaching
- Pain management
- IVF
- Coughing/deep breathing
- Foley
- Endotracheal tube/ventilator
- Communication
- Chest tubes
Cardiac surgery prep: Other
- Pre op meds
- Antiseptic scrub showers
- NPO
Pre-op vascular nursing diagnoses
- Acute/Chronic pain
- Anxiety
- Knowledge deficit
Post-op vascular nursing diagnoses
- Pain
- Ineffective airway clearance
- Impaired gas exchange
- Decreased cardiac output
- Risk for infection
- Knowledge deficit
Post op nursing care
- Pain relief
- VC, ECG
- ABGs
- I&Os
- Auscultate breath sounds
- Check incision
- Promote lung expansion
- Prevent exposure (hand hygiene, cleanse stethescope, sterile technique, monitor temp)
- Teaching (pain management, meds, activity, follow ups)
Rheumatic Heart Disease (what is it?)
- Inflammatory disease which is a delayed childhood reaction to inadequately treated childhood upper respiratory tract infection of beta-hemolytic streptococci
- Causes scar tissue in the heart
Rheumatic Heart Disease S&S
- Elevated temperature
- Elevated heart rate
- Epistaxis
- Anemia
- Nodules on the joints
- Heart murmur
- Joint pain & stiffness
- Polyarthritis
- Abdominal pain
- Lethargy
- Fatigue
Rheumatic Heart Disease Medical Management/NIs
- Prevention (treat infections rapidly and completely (antibiotics)
- Bedrest
- NSAIDs
- Application of heat
- Well-blaanced diet (supplement with vitamins B&C)
- Encourage fluids
- Commissurotomy or valve replacement
Infective carditis pathophysiology
- Invading organism attaches to endocardium
- Vegetative lesion forms
- Damages valve leaflets
- Emboli/HF possible
Infective carditis etiology
-Entry of organism into bloodstream
Infective carditis risk factors
- Immunocompromised
- Artificial heart valve
- Congential/valvular heart dz
- IV drug use
- GIngival disease
Infective carditis prevention
- Oral/dental care
- Prophylactic antibiotics per criteria
Infective carditis S&S
- Fever
- Murmur
- Petechiae (classic)
- Janeway lesions
- Osler’s nodes
Infective carditis complications
- Vegetative emboli
- Heart valve stenosis/regurgitation
- HF
Infective carditis diagnostic tests
- Blood cultures
- Echo
Infective carditis medical/NIs
- IV antimicrobial drug 8 weeks
- Bed rest
- VS q4h
- Adequate nutrition
- Report HF/emboli S&S
- Surgical valve replacement/repair
- Teaching (good hygiene & oral care) (report: fever, chills, sweat, petechaie)
Pericarditis (what is it?)
Inflammation of the pericardium
Pericarditis pathophysiology
Ventricular filling reduces (decreased cardiac output and BP)
Pericarditis etiology
- Infections, Lyme disease
- Drug reactions
- Connective tissue disorders
- Neoplastic disease
- Postmyocardial infarction
- Dressler’s syndrome
- Renal disease or uremia
- Trauma
Pericarditis S&S
- Chest pain: substernal, radiates, grating (Increases with deep inspiration)(Relieved by sitting up/forward)
- Pericardial friction rub
- Dyspnea
- Low grade fever
- Cough
Pericarditis diagnostic tests
- ECG
- Echo
- WBC
- Pericardial fluid
- CT
- MRI
Pericarditis therapeutic interventions
- Pericardiocentesis
- Treat cause (antibiotics, hemodialysis, percaridal window, pericardiectomy)
Pericarditis Medical/NIs
- VS
- Bed rest
- Cardiac function/tamponade S&S
Cardiac tamponade
Medical emergency
Too much fluid around pericardium
Goes into shock quickly
Surgery needed
Pericarditis pain relief
- NSAIDs/corticosteroids
- Position of comfort
Myocarditis (what is it?)
Inflammation of myocardium
- Rare
- Often follows virus
Myocarditis S&S
- None
- Possible viral infection S&S
- CP
- Tachycardia
Myocarditis diagnostic tests
- Endomyocardial biopsy
- MRI
- Echo
- ECG
Myocarditis therapeutic interventions
- Reduce heart’s workload
- O2
- Treat cause (antimicrobial)
- Treat HF
Myocarditis medical/NIs
- Bed rest
- VS/Cardiac status
- Diversional activities
- Energy conservation
- Education
Cardiomyopathy
- Enlagement of heart muscle
- No cure
Dilated cardiomyopathy
- Ventricular cavity enlarges
- Contractility decreases
- Stasis of blood
- Most common
Dilated cardiomyopathy S&S
- Exertional dyspnea
- Orthopnea
- Fatigue
Dilated cardiomyopathy medical/NIs
- ACE inhibitors, beta blockers, diuretics, digoxin
- Biventricular pacing
- Implantable defibrillators
- Heart transplant
Hypertrophic cardiopyopathy
Left ventricle muscle wall enlargement
- Decreases ventricular filling
- Can cause sudden death in athletes
Hypertrophic cardiopyopathy S&S
Exertional dyspnea
Angina at rest
Hypertrophic cardiopyopathy medical/NIs
- Beta blockers
- Calcium channel blockers
- Myectomy
- Septal ablation
Restrictive cardiomyopathy
- Cardiac muscle stiffness
- Impairs ventricular stretch
- Limits ventricular filling
- Systolc emptying of ventricle normal
- Rarest form
Restrictive cardiomyopathy S&S
- Exertional dyspnea
- Syncope
- Arrhythmias
Restrictive cardiomyopathy medical/NIs
- Vasodilators
- Heart transplant
Diagnostic tests for cardiomyopathy
-Cardiac workup
Therapeutic interventions for cardiomyopathy
- No cure
- Palliative care
- HF treatment
- Anticoagulants
Nursing management for cardiomyopathy
- VS
- HF/Emboli S&S
- Signs of Digoxin toxicity
- Activity tolerance/energy conservation
- Emotional support
- Patient & Family teaching (Medications, Emergency contacts, CPR, Home health care, Hospice)
Pulmonary edema
Accuulation of fluid in lung tissues and alveoli
-Complication of CHF
Pulmonary edema S&S
- Restlessness
- Agitation
- Disorientation
- Diaphoresis
- Dyspnea
- Tachypnea
- Tachycardia
- Pallor
- Cyanosis
- Cough- large amounts of blood-tinged, frothy sputum
- Wheezing, crackles
- Cold extremities
Pulmonary edema medical/NI’s
- High fowlers or orthopnic position
- Morphine sulfate
- O2
- Nitroglycerin
- Diuretic
- Inotropic agents
- Vasodilators
- Assess lung sounds frequently
