Cardiac Flashcards
Review the most important cardiac diagnostic tests and diseases.
What is a cardiac catheterization with coronary angiogram (or coronary angiography)?
It’s the use of a tube inserted into an artery in the neck, groin or arm, and then dye is injected to visualize the heart and vessels.
It is done to diagnose cardiac diseases or as an intervention to treat cardiac disease.
What are the pre-procedure interventions for a cardiac catheterization?
- ensure informed consent is signed
- assess for dye allergies
- NPO beforehand
- assess pulses and vital signs
- mark pulses with a sharpie marker
- if needed, use a doppler to locate pulses
Teaching:
Cardiac catheterization and dye
Tell client:
- that they may feel a warm flushing sensation
- an urge to urinate
- heart palpitations as the dye is being injected.
What are the post-procedure interventions for a cardiac catheterization?
- keep leg straight for 4-6 hours to prevent bleeding
- if a closure device is used, in bed for only 1-2 hours
- assess pulses and vital signs
- encourage fluids to flush out dye
What is a percutaneous transluminal coronary angioplasty (PCTA)?
A PCTA is when a balloon is used to open up an artery due to plaque build-up.
What is laser-assisted angioplasty?
Is when a laser is used to vaporize the plaque in the artery.
What is a coronary stent?
It is placed in the artery to keep it open for adequate blood flow.
What is a coronary artery bypass graft/surgery (CABG)?
A CABG is open-heart surgery that uses the client’s own veins or arteries to bypass clogged arteries.
Teaching:
Coronary artery bypass surgery (CABG)
- limit pushing and pulling for 6 weeks
- don’t cross legs
- wear compression socks and elevate limb that was used for the graft
- sex is OK if client can walk 1 block or climb 2 flights of stairs without symptoms
- weigh self daily
What is a vena cava filter?
A filter placed in the vena cava to trap blood clots.
What do the following cardiac procedures all have in common?
- cardiac catheterization
- PTCA (percutaneous transluminal coronary angioplasty)
- laser-assisted angioplasty
- coronary stents
- CABG (coronary artery bypass surgery)
- vena cava filter
All these cardiac procedures are different ways to remove or bypass plaque in the cardiac arteries to re-establish blood flow and oxygen perfusion.
Teaching:
Cardiac pre-procedure
Stop taking anticoagulants or antiplatelets about 2-7 days before the cardiac procedure in order to prevent bleeding.
What are the general pre-procedure interventions for most cardiac procedures?
Perform a baseline cardiac assessment:
- check bleeding time
- assess for hematoma formation
- vital signs
- EKG rhythm and chest pain
- peripheral pulses
- level of consciousness
What are the general post-procedure interventions for most cardiac procedures?
Assess for complications such as:
- bleeding or hematoma formation at the insertion site
- cardiac dysrhythmias and chest pain
- embolisms
- infection
What is an embolectomy?
A blood clot (embolism) removed from an artery.
What is a cardiac stress test?
Checks for coronary artery disease by making the heart work.
It can be performed on a treadmill or with IV meds to increase workload of the heart - cardiac meds are usually held before test.
What is central venous pressure?
CVP is to check pressure in the superior vena cava for cardiogenic shock. It’s checked with a central line and normal is 3-8 cm H20.
* increased CVP = FVO
* decreased CVP = FVD
The client is placed supine and the transducer is at the 4th intercostal space/mid axillary line
Describe:
Angina
Chest pain caused by inadequate myocardial blood and oxygen supply.
Explain the difference between:
1. stable angina
2. unstable angina
3. variant/prinzmetal angina
- stable angina is chest pain with physical exertion or stress: is usually relieved with nitroglycerin
- unstable angina is chest pain not related to exercise: not usually relieved with nitroglycerin and indicates a worsening situation
- variant/prinzmetal angina is from coronary artery spasm: may see ST segment elevation and client can still be considered stable
Describe:
Coronary artery disease
Plaque (fatty deposits) in the arteries that puts the client at high risk for myocardial infarction and other heart diseases.
Treatment:
Coronary artery disease
- remove plaque with cardiac procedures
-
medications
- nitrates
- antilipidemics
Teaching:
Coronary artery disease
Teach about lifestyle changes:
- stop smoking
- limit alcohol
- DASH diet
- mild to moderate daily exercise
- decrease stress
- lower cholesterol levels
Describe the difference between right-sided heart failure and left-sided heart failure.
Heart failure is the back-up of fluids in the body:
- Right-sided heart failure causes peripheral edema
- Left-sided heart failure causes back up of fluids in the lungs
Signs and symptoms:
Right-sided heart failure
- weight gain and edema
- jugular vein distention
- increased blood pressure and bounding pulse
What is this?
Pitting edema: a symptom a right-sided heart failure.
It can be 1+, 2+, 3+, or 4+.
What is this?
Jugular vein distention: a symptom of right-sided heart failure.
Interventions:
Pulmonary edema
(Immediate complication)
Goal is to get rid of extra fluids and maximize oxygen intake:
- high-Fowler’s position
- give oxygen
- diuretics and morphine (morphine eases breathing)
- foley for strict intake and output
What is the last resort treatment for pulmonary edema?
(Immediate complication)
Intubation and placed on a ventilator.
Treatment:
Cardiac tamponade
(Immediate complication)
pericardiocentesis - removal of fluid around heart with a needle.
Describe:
Valvular heart disease
When the heart valves cannot open or close completely. The blood doesn’t stay going in one direction, called regurgitation. It causes fatigue in the client.
Client is high risk for blood clots.
Treatment:
Valvular heart disease
- possible valve replacement
- will need prophylactic antibiotics before any surgery or invasive procedure, including dental work
Teaching:
Valvular replacement surgery
- will be on anticoagulants
- good oral hygiene to prevent endocarditis
- no flossing or electric toothbrush due to bleeding and risk of infection
- no dental procedures for 6 months
- prophylactic antibiotics before invasive procedures
Describe:
Deep vein thrombosis (DVT)
DVT is a blood clot in an extremity, usually more common in the calf.
Clients who are sedentary are a higher risk, especially post-operative clients.
Prevention:
Deep vein thrombosis
- anti-embolism stockings
- sequential compression devices
- adequate fluid intake
- ambulation
- ankle pumps and elevate legs
- no smoking
- possible subQ heparin or lovenox
What are the characteristic signs and symptoms of deep vein thrombosis?
-
pain when leg is dorsiflexed (positive Homan’s sign)
- don’t ask client to do this if DVT is suspected due to clot breaking loose
- warm and tender skin
- one calf is bigger
Interventions:
Deep vein thrombosis
- bedrest with bathroom privileges
- elevate extremity above the heart
- avoid bending the knee
- no massage
- warm, moist compresses
- measure calf
Medications:
Deep vein thrombosis
- thrombolytics
- heparin IV
- warfarin
- pain meds
Describe:
Varicose veins
Small broken veins on the surface of extremities due to increased pressure in the veins
Interventions:
Varicose veins
- elevate extremities as much as possible
- possible sclerotherapy (vein stripping)
Describe:
Venous insufficiency
When the veins cannot bring blood back to the heart.
It is usually caused by chronic hypertension stretching the veins and valves. Clients frequently get ulcers on ankles.
What are the characteristic signs and symptoms of venous insufficiency?
- brown skin from ankle and up to calf
- ulcers around ankles
- edema
Blood is unable to travel back up to heart. Nutrients and oxygen are unable to reach lower legs.
Interventions:
Venous insufficiency
- “Elevate vEins” - keep the legs elevated to promote blood flow back to the heart
- wear compression stockings
- possible wound care for ulcers
Describe:
Peripheral arterial disease
Occlusion of the arteries due to atherosclerosis (plaque buildup).
What are the characteristic signs and symptoms of peripheral artery disease?
Intermittent claudication - pain in the muscles due to low blood supply. Also:
* hair loss
* ulcers
* numbness
* brittle toenails
* dry skin
* decreased peripheral pulses
Interventions:
Peripheral artery disease
- “dAngle Arteries” - keep the legs below the level of the heart to promote blood flow to lower legs
- possible surgery to remove plaque
- PCTA, angioplasty, atherectomy, bypass surgery
- encourage ambulation to increase blood flow
Describe:
Raynaud’s phenomenon
Poor circulation which causes pain, numbness/tingling and a red, white and blue color in the extremities.
The cause is unknown but is associated with cold weather, stress and more common in women.
Describe:
Buerger’s disease (Thromboangiitis obliterans)
Poor circulation which causes pain, numbness/tingling and a purple color in the extremities.
The cause is unknown but is associated with smoking and more common in men.
Describe:
Aortic aneurysm
(Immediate complication)
Stretching of the arterial wall in the abdomen.
If it ruptures, the client will experience pain, difficulty breathing, abrupt tearing sensation in back, and signs of shock.
What is an AAA resection (abdominal aortic aneurysm resection)?
When a graft is placed where there is an aneurysm.
What do the following cardiac conditions all have in common?
- pericarditis
- myocarditis
- endocarditis
The are all inflammatory and infectious diseases of the heart.
What are the general interventions for inflammatory heart diseases?
- monitor for and prevent infections
- antibiotics
- assess for heart failure and dysrhythmias and treat if these complications occur
Diagnostic test:
Deep vein thrombosis
Duplex ultrasonography to assess blood flow.
