Cardiac Flashcards
function of the SA node
pacemaker
60-100 beats/min
function of the AV node
receives impulses from SA node
if SA node fails, AV node starts
40-60 beats/min
function of purkinje fibers
acts as pacemaker when SA and AV nodes fail
20-40 beats/min
what happens when the coronary arteries are blocked?
increased risk of MI
heart sounds
1st (S1): heard at apex of heart
2nd (S2): heard at base of heart
3rd (S3): occurs with heart failure and regurg
4th (S4): atrial asystole, abnormal, causes cardiac hypertrophy disease or injury
sinus tach
> 100 beats/min
faster the heart rate the less cardiac output
sinus brady
<60 beats/min
treat if patient is symptomatic (decreased cardiac output)
low HR is normal for athletes
what does renin do?
vasoconstriction
increases BP
what does vasopressin (ADH) do to BP
ADH influences regulation of vascular volume.
when there is an increase blood volume less ADH will be released, increase urination, decreasing blood voulme and BP
when there is a decrease in blood volume more ADH will be released, which promotes blood volume to increase and increase BP
arteries
take oxygenated blood AWAY from heart
veins
transport deoxygenated blood to the heart
troponin
protein that increases with an MI
rises within 3 hours and last 7-10 days
normal level < 0.3
myoglobin
oxygen binding protein that rises within 2 hrs of cell death
RBC
4.2-6.1
decreases in rheumatic heart disease and infective endocarditis
increases in conditions where there is an inadequate tissue oxygenation
WBC
5-10
increases with infection and inflammation and after MI
H&H
hgb 12-18
hct 32-57
elevated hct: vascular volume depletion
decreased H&H: anemia
effects of potassium on the heart
hypokalemia: ventricular dysrythmias and increase risk of dig toxicity. flat and inversed T wave, U wave, and depression of ST
hyperkalemia: asystole and ventricular dysrhythmia. tall peaked T wave, wide QRS complex, prolonged PR intervals, flat P waves
effects of sodium on heart
decreases with diuretics
decreases with heart failure
effects of calcium on heart
hypocalcemia: ventricular dysrhythmias, prolonged ST and QT interval, and cardiac arrest
hypercalcemia: short ST segment and wide T wave, AV block, tachycardia or bradycardia, dig hypersensitivity and cardiac arrest
effect of phosphorus on heart
interpreted with calcium levels because kidney retain or excrete one or the other
when calcium is high phosphorus is low or vice versa
effects of mag on heart
low mag: vtach or vfib
tall T wave
depressed ST segment
high mag: muscle weakness hypotension and bradycardia.
long PR interval
wide QRS
BUN and heart
elevated BUN with heart failure and cardiogenic shock due to effects on renal circulation
BNP
anything >100 is heart failure
meanings of the ECG components
reflects electrical activity of cardiac cells and record electrical activity
P wave: atrial depolarization
PR interval: time it take impulse to get from atria to AV nose bundle of his to purkinje fibers (0.12-0.2 sec)
QRS complex: ventricular depolarization (0.04-0.1 sec)
ST segment: early ventricular repolarization
T wave: ventricular repolarization
U wave: follows T wave and indicates electrolyte issues
QT interval: total time required for ventricular depolarization and repolarization (0.32-0.4)
ECG
noninvasive diagnostic test that records electrical activity of the heart
used to detect cardiac issues, location and extent of MI and cardiac hypertrophy
ECG interventions
lie still breathe normally no talking electrical shocks will NOT occur document any heart meds the patient is taking
holter monitoring
noninvasive
patient wear monitor that continously records ECG
identifies dysrhythmias
evaluates effectiveness of antidysrhytmic meds or pacemaker
holter monitor care
resume normal daily activities
maintain diary of activities and s/s that develops
avoid tub baths or showers
echocardiography
noninvasive ultrasound that evaluates structural and functional changes in the heart
used to detect vale issues, congenital heart defects, wall motion, ejection fraction and cardiac function
echocardiography care
lie still
breathe normally
no talking
stress test
noninvasive test that studies the heart during activity
detects and evaluates coronary artery disease
treadmill test is most common
if patient can NOT tolerate exercise; IV dipyridamole or dobutamine is give to dilate coronary arteries and simulate effect of exercise: patient is NPO 3-6 hrs before test
before the stress test
informed consent (if using IV option)
adequate rest the night before
light meal 1-2 hrs before
no smoking, ETOH, caffeine
check with MD about which meds to hold
(usually calcium channel blockers and beta blockers are held the day of the test)
wear loose comfy clothes and supportive shoes
report to MD any chest pain, dizziness, SOA
after stress test
no hot bath or shower for at least 1-2 hrs after
before an MRI
check to see if patient has a pacemaker or other implanted devices that would be contraindicated
remove all metallic objects
may have claustrophobia due to tight space
cardiac cath
invasive test involving insertion of catheter into heart
before cardiac cath
informed consent
assess for allergies to seafood iodine or dye (may be given antihistamines and steroids to prevent reaction)
NO solid food 6-8 hrs before and NO fluids 4 hrs before to prevent aspiration and vomiting
ht and wt to determine amount of dye needed
baseline VS
check pulses
inform about local anesthetic
may feel fluttery feeling as catheter passes through heart
flushed and warm feeling when dye injected
desire to cough and palpitations caused by irritated heart
shave and clean site with antiseptic solution
metformin and dye
withhold metformin for 24 hrs before procedures with dye because it can lead to lactic acidosis
not to be given again until after procedure when MD says it is ok or when renal function is evaluated (usually 48 hrs)
after cardiac cath
check VS and heart rhythm at least q 30 mins for 2 hrs check for chest pain report chest pain and dysrhythmias check pulses and color of extremities report numbness and tingling report cool pale or cyanotic extremity report loss of pulses sandbag or compression device check for bleeding if bleeding: apply manual pressure ASAP and report check for hematoma and report ASAP keep extremity extended for 4-6 hours (leg needs to stay straight) bed rest for 6-12 hrs HOB NO HIGHER THAN 15 DEGREES increase fluids
percutaneous transluminal coronary angioplasty
PTCA
invasive nonsurgical
arteries are opened up with balloon catheter to improve blood flow
patient needs to completely stop smoking, change diet, lose weight, LIFESTYLE CHANGES
before the percutaneous transluminal coronary angioplasty (PTCA)
SAME AS CARDIAC CATH
report chest pain during balloon inflation
may be given aspirin before
informed consent
assess for allergies to seafood iodine or dye (may be given antihistamines and steroids to prevent reaction)
NO solid food 6-8 hrs before and NO fluids 4 hrs before to prevent aspiration and vomiting
ht and wt to determine amount of dye needed
baseline VS
check pulses
inform about local anesthetic
may feel fluttery feeling as catheter passes through heart
flushed and warm feeling when dye injected
desire to cough and palpitations caused by irritated heart
shave and clean site with antiseptic solution with antiseptic solution
after the percutaneous transluminal coronary angioplasty (PTCA)
SAME AS CARDIAC CATH give anticoags and antiplatelets IV nitro increase fluids daily aspirin lifestyle changes
check VS and heart rhythm at least q 30 mins for 2 hrs check for chest pain report chest pain and dysrhythmias check pulses and color of extremities report numbness and tingling report cool pale or cyanotic extremity report loss of pulses sandbag or compression device check for bleeding if bleeding: apply manual pressure ASAP and report check for hematoma and report ASAP keep extremity extended for 4-6 hours (leg needs to stay straight) bed rest for 6-12 hrs HOB NO HIGHER THAN 15 DEGREES increase fluids
coronary artery stents
used in conjunction with PTCA to eliminate risk of vessel closure and improve vessel long term
reopening of blocked vessels
care for coronary artery stents
major concern is thrombosis (clot formation)
antiplatelets (clopidogrel or aspirin) months before
check for complications: stent migration or occlusion, coronary artery dissection, bleeding from anticoags
similar to PTCA check VS and heart rhythm at least q 30 mins for 2 hrs check for chest pain report chest pain and dysrhythmias check pulses and color of extremities report numbness and tingling report cool pale or cyanotic extremity report loss of pulses sandbag or compression device check for bleeding if bleeding: apply manual pressure ASAP and report check for hematoma and report ASAP keep extremity extended for 4-6 hours (leg needs to stay straight) bed rest for 6-12 hrs HOB NO HIGHER THAN 15 DEGREES increase fluids
atherectomy
removes plaque from artery
improves blood flow to limbs in patients with PAD
atherectomy care
cheek for complications of perforation, embolus, or re-occlusion
similar to PTCA check VS and heart rhythm at least q 30 mins for 2 hrs check for chest pain report chest pain and dysrhythmias check pulses and color of extremities report numbness and tingling report cool pale or cyanotic extremity report loss of pulses sandbag or compression device check for bleeding if bleeding: apply manual pressure ASAP and report check for hematoma and report ASAP keep extremity extended for 4-6 hours (leg needs to stay straight) bed rest for 6-12 hrs HOB NO HIGHER THAN 15 DEGREES increase fluids
transmyocardial revascularization
for patients with widespread atherosclerosis in vessels that are too small
uses high power laser that creates 20-24 channels that provide region of heart with oxygenated blood
peripheral arterial revascularization
increases arterial blood flow to limbs
bypassing occlusions
before the peripheral arterial revascularization
check baseline VS and pulses
insert IV and foley
maintain central line or art line
after the peripheral arterial revascularization
check VS and report changes
check for hypotension: hypovolemia
check for hypertension: stress on graft and causes clot
bed rest for 24 hrs
keep affected extremity stright
limit movement
no bending at knee or hip
check for warm, red, edema: EXPECTED OUTCOMES that means there is an increased blood flow to area
check for graft occlusion
check pulses , changes in color and temp
check incision for drainage, warmth or swelling
small amount of bleeding is EXPECTED
too much bleeding is bad
check graft for infection: hardness, tender, warm and report to MD
foot care and ulcer prevention
modify lifestyle
MONITOR FOR SHARP INCREASE IN PAIN BECAUSE THIS IS THE FIRST INDICATOR OF POSTOP GRAFT OCCLUSION: NEEDS TO BE REPORTED TO MD
coronary artery bypass grafting (CABG)
bypassing of an occluded artery
used when patient does NOT respond to medical management of coronary artery disease
before the coronary artery bypass grafting (CABG)
expect sternal incision, chest tubes, foley, and multiple IV sites
ET tube placed for a short time and pt will not be able to speak
will be mechanical vented
patient needs to breathe with vent and not fight it
discontinue certain meds: diuretics 2-3 days before, dig 12 hrs before, aspirin and anticoags 1 week before
give potassium, antihypertensives, antidysrhythmics, and antibiotics
after the coronary artery bypass grafting (CABG)
mechanical vent
monitor HR, rhythm, urine output, and neuro status
report chest tube drainage greater than 75 ml/ht
monitor fluid and electrolytes
fluid restriction d/t edema
hypotension collapses graft
hypertension promotes leakage causing bleeding
check temp
rewarm patient using warm thermal blankets if temp less than 96.8
rewarm no faster than 1.8 degrees/hr to prevent shivers
discontinue rewarming when temp gets to 98.6
IV potassium to maintain potassium between 4-5
check s/s cardiac tamponade: sudden cessation of heavy mediastinal drainage, JVD with clear lung sounds, equalization of right atrial pressure and pulmonary wedge pressure, and pulsus paradoxus
pulsus paradoxus
abnormally large decrease in stroke volume and bp during inspiration
transfer patient from the CICU
check VS check LOC check perfusion check for dysrhythmias listen to lungs assess respiratory spline incision cough deep breathe and IS to prevent atelectasis check temp check WBC give fluids to liquefy secretions assess suture line and chest tube insertion for infection assess sternal suture for infection gradually resume activity assess for tachycardia, ortho hypotension and fatigue discontinue activities if BP drops more than 10-20 mm Hg or if pulse increase more than 10 beats/min
heart transplant
donor heart must have comparable body weight and ABO compatibility
transplanted within less than 6 hrs
will have 2 unrelated P waves on ECG because part of atria is left in from old heart
new heart is denerved and does NOT respond to vagal stimulation (will not have angina d/t denerving of heart)
endomyocardial biopsies performed regularly and when rejection expected
required lifetime immunosuppressives
strict aseptic technique and hand washing
s/s heart rejection
hypotension dysrhythmias weakness fatigue dizziness
home care for patients with cardiac surgery
slowly return to activities limit pushing or pulling activities for 6 wks monitor incision for infection sternal incision should heal 6-8 wks no crossing legs no panty hose till edema is gone no elevating surgical limb when sitting no saturated fats no cholesterol no salt can resume sex if patient can walk 2 block or climb 2 flights of stairs without s/s
normal sinus rhythm
SA nose
60-100 beats/min
sinus brady interventions
determine cause of brady if med is causing brady: withhold med and notify MD give O2 give atropine to increase HR transcutaneous pacemaker if atropine does NOT work NO extra atropine: causes tachycardia check for hypotension and give fluids may need permanent pacemaker
sinus tach interventions
find the cause
decrease HR to normal by treating cause
a fib
multiple rapid impulses from multiple atrial depolarizations
atria quivers leading to thrombi
no P wave; just wiggly lines before the QRS
a fib interventions
give O2
give anticoags
give cardiac meds to control ventricular rhythm and assist in maintenance of cardiac output
cardioversion
PVC premature ventricular contractions
early ventricular contractions resulting from increase irritability of ventricles
unifocal or multifocal QRS
upside down QRS
PVC premature ventricular contractions interventions
ID cause and treat
check O2 sat for hypoxia: can cause PVC
check electrolytes (potassium): can cause PVC
O2 and meds in cause of acute MI
NOTIFY MD IF PATIENT COMPLAINS OF CHEST PAIN OR IF PVCS INCREASE IN NUMBER ARE MULTIFOCAL OCCURE ON T WAVE OR OCCUR IN RUNS OF VTACH
v tach
repetitive firing of irritable ventricles
leads to cardiac arrest
stable patients with sustained vtach
with pulse and no s/s of decreased cardiac output
give O2
give antidysrhythmics
unstable patient with vtach
with pulse and s/s of decreased cardiac output
give O2
give antidysrhythmics
cardioversion if patient is unstable
cough CPR: coughing hard every 1-3 secs
pulseless patient with vtach
defib and CPR
vfib
chaotic rapid rhythm where ventricles quiver and there is NO cardiac output
fatal if not stopped within 3-5 mins
lack pulse, BP, respirations, heart sounds, and is unconscious
vfib interventions
CPR until defibrillator gets there check entire length of patient 3 times to make sure no one is touching the patient or the bed when clear: defib CPR another 2 mins reassess cardiac rhythm give O2 give antidysrhythmic
vagal maneuvers
induce vagal stimulation to terminate SVTs
carotid sinusmassage
instruct patient to turn head away from side that is being massaged
massage 1 carotid for a few seconds to determine change in rhythm
patient must be on cardiac monitor
check ECG strips before during and after
document
have defibrillator and CPR equipment at bedside
check VS, cardiac rhythm, and LOC after
valsalva maneuver
instruct patient to bear down or induces gag reflex to stimulate vagal response
check HR, rhythm, BP
record ECG before during and after
provide emesis basin if gag reflex is stimulated
aspiration precautions
have defib and CPR equipment in room
cardioversion
synchronized countershock to convery undesirable rhythm to stable
pre-cardioversion
if elective, ensure informed consent is obtained
if elective hold dig for 48 hrs before
if elective for afib or aflutter: patient should get anticoags for 4-6 weeks before
give sedative
during cardioversion
ensure skin is clean and dry in area where electrode pads will be placed
stop O2 to avoid fire hazard
make sure no one is touching the bed or patient when giving the shock (check 3 times before shocking)
post-cardioversion
priority: maintain airway and breathing resume O2 check VS check LOC check cardiac rhythm check for indications of successful response: conversion to sinus rhythm, strong pulses, adequate BP and urine output check skin on chest for burns from pads
defib
countershock for pulseless vtach and vfib
1 defib then 5 cycles (2mins) of CPR
reassess after 2 mins
shock again
BEFORE SHOCKING MAKE SURE O2 IS TURNED OF TO AVOID FIRE HAZARD AND BE SURE THAT NO ONE IS TOUCHING THE BED OR THE PATIENT
pad electrodes
1 pad on 3rd intercostal space to right of sternum
1 pad on 5th intercostal space on left of midaxillary line
apply firm pressure to each pad (25lbs)
make sure no one is touching bed or patient for shock
AED
place patient on firm dry surface
stop CPR
make sure no one is touching patient or bed
place electrode patches in correct spots
press analyzer button
shock for pulseless vtach or vfib ONLY (up to 3 shocks)
if unsuccessful, CPR is continued for 1 min and the another 3 shocks are given
automated implanted cardioverter-defibrillator
monitors cardiac rhythm and detects and terminated episodes of vtach and vfib
used in patients with episodes of spontaneous sustained vtach or vfib
planted in left pectoral
automated implanted cardioverter-defibrillator education
wear loose fitting clothes
avoid contact sports to prevent trauma
report fever redness welling or drainage from site
report fainting nausea weakness blackouts and rapid pulse rates
during shock discharge, patient may feel faint or short of breath
instruct patient to sit or lie down if they feel a shock and report
maintain log of date time and activity before the shock, s/s before shock, and postshock sensations
encourage family to learn CPR
avoid electromagnetic fields (airport security)
move away from magnetic fields if beeping tones are heard and report
pacemakers
device that provide electrical stimulation and maintains the HR when patient’s heart can no longer be the pacemaker
temporary pacemaker: noninvasive transcutaneous pacing
used as temporary emergency measure in patients with profound bradycardia or asystole
electrode pads placed on check and back and connected to external generator
wash skin with soap and water before applying electrodes
no need to shave hair or apply alcohol
posterior electrode goes between the spine and left scapula behind the heart: avoid placing on bone
place anterior electrode between V2 and V5 positions over the heart: do not place over female breast tissue, place under breast
do not take pulse or BP on left side
set pacing rate
temporary pacemaker: invasive transcutaneous pacing
pacing lead wire placed through antecuital, femoral, jugular, subclavian vein into right atrium or right ventricle
check insertion site
restrict patient movement to prevent displacement
reducing risk of microshock
use only inspected and approved equipment
insulate exposed portion of wires to plastic or rubber (rubber gloves)
ground all electrical equipment using 3 pronged plug
wear gloves when handling wires
keep dressings dry
VS ARE MONITORED AND CARDIAC MONITORING IS DONE CONTINUOUSLY FOR CLIENT WITH PACEMAKER
permanent pacemakers
surgical implantations in subcutaneous pocket below clavicle
limit arm movement postop to prevent wire dislodgement
powered by lithium battery with average life span of 10 years
pacemaker education
teach about programmed rate
teach s/s of battery failure and when to report to MD
report fever, redness, swelling, or drainage
report dizziness, weakness, fatigue, swelling of ankles or legs, chest pain, or SOA
teach how to take pulse
take pulse daily and keep diary
wear loose fitting clothes over site
no contact sports
inform all HCP that pacemaker is inserted
inform airport security about pacemaker because it will set off the alarms
most electrical appliances can be used without interference
do not operate electrical appliances directly over pacemaker
avoid transmitter towers and anti-theft devices in stores
move 5-10 feet away and check pulse if unusual feelings occur near electrical devices
important to follow up with MD
use cellphones on opposite side of the pacemaker
coronary artery disease
narrowing or obstruction of arteries d/t atherosclerosis
causes decreased perfusion and inadequate O2 supply
leads to HTN, angina, dysrhythmias, MI, heart failure, death
coronary artery disease s/s
chest pain palpitations dyspnea syncope cough or hemoptysis excessive fatigue
can lead to ischemia of the heart
coronary artery disease diagnostic tests
ECG
cardiac cath
blood lipid levels
coronary artery disease care
find risk factors that can be modified set goals to promote lifestyle changes low calorie low sodium low cholesterol low fat diet increase fiber dietary changes are for life increase exercise stop smoking reduce stress
coronary artery disease meds
nitrates
calcium channel blockers
cholesterol lowering meds
beta blockers
angina
chest pain from heart ischemia from lack of blood and O2 to heart
goal of angina treatment
provide relief from acute attack, correct imbalance between heart O2 supply and demand, and prevent progression of disease and further attacks to reduce risk of MI
stable angina
occurs with activities that involves exertion or emotional stress
relieved with rest or nitro
stable pattern
unstable angina
unpredictable degree of exertion or emotion
increases in occurrence duration and severity
NOT RELIEVED WITH NITRO
variant angina
from coronary artery spasm
occurs at rest
associated with ST segment elevation on ECG
intractable angina
chronic incapacitating angina that does NOT respond to treatment
preinfarction angina
acute coronary insufficiency
last longer than 15 mins
s/s of worsening cardiac ischemia
chest pain that occurs days to week before MI
angina s/s
substernal crushing squeezing pain
pain may radiate to shoulders, arms, jaw, neck, back
pain usually lasts less than 5 mins but can last up to 15-20 mins
pain relieve by nitro and rest
dyspnea pallor sweating palpitations tachycardia dizzy syncope hypertension digestive issues
angina diagnostic
ECG stress test cardiac enzyme troponin cardiac cath
angina care
give nitro cardiac monitoring give O2 bed rest semi fowlers stay with patient obtain 12-lead ECG get IV access
acute angina episode
stop activity rest nitro call 911 if nitro does not relieve pain aspirin
MI
ischemia that leads to necrosis
infarction occurs over several hours
MI diagnostics
troponin level rise w/in 3 hrs and remains elevated for 7-10 days
CK level
WBC count
ECG
MI s/s
women experience atypical s/s: SOA and fatigue
crushing substernal pain that radiate to jaw back and left arm
pain without cause (early in the AM)
pain unrelieved by rest or nitro
only relieved by opioids
pain lasts 30 mins or longer
n/v sweating dyspnea dysrhythmias fear anxiety pallor cyanosis cool extremities
MI care
PAIN RELIEF INCREASES O2 SUPPLY TO HEART; GIVE MORPHINE AS PRIORITY IN MANAGING PAIN TO PATIENT WITH MI
MONA: morphine, O2, nitro, aspirin
check RR, HR
check for crackles or wheezes or edema
bed rest
semi fowlers
stay with patient
get IV access
obtain 12-lead ECG
check for tachycardia or PVCs because they occur hours after MI: give antidysrhythmics
give anti thrombolytic and check for bleeding
check pulses and skin temp because poor cardiac output (cool sweaty skin and decreased pulses)
check BP
give beta blockers to slow HR and increase myocardial contraction
acute MI episode
bed rest
stand to void or use bedside commode
ROM exercises to prevent thrombus formation
maintain muscle strength
progress to dangle legs at side of bed or out of bed to chair for 30 mins 3 times/day
progress to ambulation in patients room and to bathroom and then hallway 3 times/day
check for complications
give ACE, ARBs, calcium channel blockers, aspirin, clopidogrel, lipid lowering meds
heart failure
impaired pumping ability that leads to inability of heart to maintain adequate cardiac output
decreased tissue perfusion
right sided heart failure
edema JVD abdominal distention hepatomegaly splenomegaly anorexia nausea weight gain nocturnal diuresis swelling of fingers and hands increased BP from increased fluid volume decreased BP from pump failure
left sided heart failure
pulmonary congestion dyspnea tachypnea tachycardia crackles nasal flaring use of accessory muscles wheezing blood frothy sputum dry hacking cough nocturnal dyspnea cold clammy skin cyanosis increased BP from increased fluid volume decreased BP from pump failure
pulmonary edema priority nursing actions
high fowlers legs in dependent position high flow O2 assess lung sounds get IV access give diuretic (furosemide) and morphine insert foley prepare for intubation and vent document
can give dig and bronchodilators
after acute episode with heart failure
dig diuretics ace inhibitor beta block vasodilator no OTC no large amounts of caffeine (coffee, tea, cocoa, chocolate, carbonated drinks) eat K+ rich foods fluid restriction suck on hard candy to reduce thirst rest periods avoid isometric activities daily weights report signs of fluid retention (edema or weight gain)
cardiogenic shock
failure of heart to pump
goal of treatment is to maintain tissue oxygenation and perfusion and improve pumping of heart
cardiogenic shock s/s
hypotension decreased urine output cold clammy skin poor pulses tachycardia tachypnea pulomonary congestion restless chest discomfort
cardiogenic shock care
give O2 give morphine IV intubation and mechanical vent give diuretics and nitrates give vasopressors and inotropes check ABGs check urinary output
central venous pressure
pressure within SVC
pressure in which blood is returned to SVC
measure CVP
transducer needs to be at level of right atrium
position supine with HOB at 45 degrees
no coughing or straining
to maintain patency: continuous small amount of fluid delivered under pressure
mean arterial pressure (MAP)
60-70
pericarditis
inflammation of pericardium
pericardial sac becomes inflamed
pericarditis s/s
anterior chest pain that radiates to left side of neck, shoulder, or back
pain made worse by breathing, coughing, swallowing
pain worse in supine position and relieved by leaning forward
pericardial friction rub
fever
chills
fatigue
elevatedWBC
ECG changes (ST elevation, afib)
pericarditis care
high fowlers or upright and leaning forward
give O2
give pain meds (NSAIDs or steroids)
listen for pericardial friction rub
check blood cultures to find cause
give antibiotics for bacterial infection
give diuretics and dig
check for cardiac tamponade and report to MD
myocarditis
inflammation of myocardium d/t pericarditis, systemic infection, or allergies
myocarditis s/s
fever dyspnea tachycardia chest pain pericardial friction rub gallop rhythm murmur that sounds like fluid passing an obstruction pulsus alternans s/s heart failure
myocarditis care
sit up and lean forward give O2 pain meds, aspirin, NSAIDS dig antidysrhythmics antibiotics check for complications: thrombus, heart failure, cardiomyopathy
endocarditis
inflammation of inner lining of the heart and valves
IV drug abusers (need a replacement valve)
endocarditis s/s
fever anorexia weight loss fatigue cardiac murmurs heart failure vegetation fragments petechiae splinter hemorrhages on nail beds oslers nodes (red tender lesions on pad of fingers, hands, toes) janeway lesions (nontender hemorrhagic lesions) splenomegaly clubbing of fingers
endocarditis care
schedule rest
antiemolism stockings
check for s/s heart failure
check for splenic emboli (sudden abdominal pain radiating to left shoulder and presence of rebound abdominal tenderness)
check for renal emboli (flank pain radiating to groin, hematuria, and pyuria)
check for confusion, aphasia, or dysphasia
check for pulmonary emboli
check blood cultures
give antibiotics
endocarditis education
aspetic technique during setup and administration of IV antibiotics
IV antibiotics are scheduled
check IV site for s/s infection
report s/s infection
record daily temp for up to 6 weeks
report temp
oral hygiene twice a day with soft tooth brush
rinse well with water after brushing
avoid oral irrigation devices and flossing
cleanse skin lacerations and apply antibbiotic ointment
inform all HCPs about condition and get prophylactic antibiotics before respiratory and dental procedures
