Cardiac Flashcards
s/s heart disease
dyspnea
orthopnea
paroxysmal nocturnal dyspnea
consider also sleep apnea
CPAP
constant positive airway pressure
BiPAP
bi level positive airway pressure
BiPAP function
assists in breathing
helps keep airway open and lungs inflated
cardiac assessment
edema weight gain syncope palpations fatigue chest pain
cardiac conditions causing chest pain
ischemic heart disease
pericarditis
aortic dissection
non cardiac conditions causing chest pain
pleurisy
pulmonary embolism
hiatal hernia
anxiety
chest pain assessment
quality intensity association manifestations aggravating factors relieving factors age gender
troponin I
enzyme specific to heart muscle, immediately released, lasts for 1 week
LDH
lactic dehydrogenase
rises within 8-12 hours post MI
persists for 8-14 days
CK-MB
creatine kinase myoglobin
rises for first 3 days POST MI
ESR
erythrocyte sedimentation rate
elevated in cardiac muscle damage
females - up to 20 mm/hr
males - up to 15 mm/hr
myoglobin
O2 binding protein found in cardiac and skeletal muscle
peaks in 4-6 hours
CK
poor marker
injured skeletal muscle peaks in 12-18 hours
CRP
marker for inflammation, may include infection
homocysteine levels
elevated levels are associated with coronary vessel disease
elevated >16 pmol/L
BNP
brain natriuretic peptide
what is BNP specific to?
CHF
what does BNP help regulate
BP and fluid volume
where is BNP excreted from?
ventricles
what response is BNP excreted due to
in response to increase preload
what level of BNP is considered mild vs severe CHF
mild - 51.2pg/mL
severe - >1000pg/mL
nursing interventions for cardiac disease
lifestyle changes
behavioral modifications
education about pharmacological therapy
what kinds of lifestyle changes are involved
dietary exercise smoking cessation reduction of stress use of support system
how many calories are allotted per day by AHA and ADA?
1200 women
1600 men
nutrition can impact?
HTN
dyslipidemia
glucose levels
DASH diet
an eating plan for lowering HTN and reducing obesity
DASH diet emphasis
fruits, nuts, veggies
low fat diary
complex carbs
restricts saturated fats and sodium
mediterranean diet characteristics?
doesn’t emphasize low fat dairy
no Na restriction required
favorable impact on obesity and other metabolic factors
is mediterranean diet vs DASH diet in reducing HTN
not as effective
result of reducing intake of simple carbs
reduces avg glycosylated hb (A1C)
atherogenic diet
eating pattern compromised of high level of fat and refined carbs.
linked to elevated triglycerides and reduced levels of high density lipoprotein cholesterol (HDL -C)
which fats do you consume less of to reduce weight?
saturated fats
transfats
refined carbs
which oil reduces plasma lipid profile and reduces blood pressure?
Fish oil - omega 3
recommended exercise?
aerobic
30 min/day 5 days/week
undertaken slowly
increases based on client tolerance
smoking interventions
educate patient on benefit record # of cigs smoked daily for 1 week review diary and ask patient to select time they can avoid recommend support group medications
which hormones does stress release?
NE, epinephrine, cortisol
types of meds for cardiac patients
cardiac meds
cholesterol lowering meds
antithrombotic meds
patient teaching for cardiac
monitor BP
keep journal of diet, exercise, BP, Glucose
types of meds prescribed for CHF or HTN
diuretics
common diuretics
Loop - Furosemide (Lasix)
Potassium sparing - Spironolactone (Aldactone)
s/e of thiazides
increase Glu
decrease K+
s/e of loop diuretics
low K+ levels
dizziness
may need sunscreen
s/e of K+ sparing diuretics
monitor K+ levels
avoid Na and K substitutes
purpose of ace inhibitors
vasodilation
inhibits conversion of angiotensin from the lung
ARBS
angiotensin II receptor blockers
ie: Benicar
restructures the heart
how are ace inhibitors and arbs effective
protect the kd function
control HTN
prevent inschemic cardiovascular disease
ace inhibitor s/e
persistent cough
may increase K+
ARB s/e
dizziness
may increase K+ levels
when are Ca Chan blockers prescribed?
post CHF and MI (Procardia)
for HTN
beta blockers are also used for?
HTN post CHF (inderal)
example of alpha blocker
Minipress
s/e of Ca chan blockers
SOB, peripheral edema, slows heart rate
education about Ca chan blockers
use TED hose
beta blocker s/e
dizziness
fatigue
exercise intolerance
wheezing
beta blocker teaching
monitor VS
do not stop abruptly - rebound
selective vs non selective
masks low blood sugar
alpha blockers teaching
orthostatic hypotension
masks low blood sugar
who is prescribed alpha blockers
Bph patients
direct vasodilators s/e
Apresoline
h/a
fluid retention
fast heart rate
Catapres teaching
do not stop abruptly
fatigue
digoxin
cardiac glycoside
prescribed post CHF and tachyarrhythmia
action of digoxin
increases intracellular ca and allows more ca to enter cell during depolarization
prolongs action potential
slows conduction and HR
increases force of myocardial contraction
interventions for digoxin
check apical HR before administer - need to check > 1 min; > 60 BPM
watch for toxicity - drowsy, abd pain, anorexia, vomiting, visual disturbance and yellow halos
check other labs - K, Ca, Mg
monitor digoxin levels -
statin s/e
Lv Kd function affected
muscle pain - Rhabdomyolysis
fibric acid derivative s/e (Lopid)
Lv function
muscle pain
Niacin s/e
flushing - feels like skin burning off
Lv affected
increase Glu level
what else is prescribed in addition to statin (lipitor) for high cholesterol
fibrate acid derivative (Lopid) Niacin cholesterol absorption inhibitor (Zetia) Lipid combo (Vytorian) Bile Acid sequestrant (Questran)
Bile acid sequestrant teaching
can’t take with other meds
aka metamucil
Zetia s/e
monitor Lv enzymes
Vytorian s/e
muscle pain
monitor Lv enzymes
Questran s/e
GI disturbance
watch dosing schedule
mechanism of drug food interaction with grapefruit
involving specific isoform of cytochrome p450 cyp3a4 present in Lv and intestinal wall
