cardiac disorders pt. 3 Flashcards
impairment of the abilityof the ventricle to fill or eject blood effectively (pump issue)
heart failure
what can heart failure result from?
acute MI
uncontrolled HTN
valvular dysfunction
infection
cardiomyopathy
what is a complication of HF that is stiffening and enlarging of the heart
ventricular remodeling (bad)
L sided HF sx
Left side = backed up to lungs
-SOB
-orthopnea
-crackles
-elevated PAWP (wedge), PAOP, PAP
R sided HF sx
R side = backed up from entering heart
-lower extremity edema
-JVD
-hepatojugular reflux
elevated CVP
what is secreted by the ventricles in response to excessive stretching of heart muscle cells (compensating)
B-tyoe natriuretic peptide (BNP)
what does BNP do to the body
stops RAAS
what is the BNP diagnostic level for HF
> 100
what is the marker of cardiac dysfxn and is correlated with LV preload
BNP
Interventions management of HF (3)
-meds
-cardiac resynchronization therapy (pacing)
-ICD (defibrillator)
elements of self-management of HF
adherence to drug regimen
daily weight
low sodium diet
exercise
smoking and alcohol cessation
what kind of meds should be used for HF (in regards to preload, afterload, and contractility)
preload reduction
afterload reduction
+ inotropes
what 2 devices are used for HF?
intraaortic balloon pump
levt ventricular assist devices (LVAD)
what 2 meds reduce preload for HF?
diuretics
nitrates (nitroglycerin)
which 3 meds decrease afterload for HF?
ACE-I/ARB
hydralazine
nitroprusside
what is important to monitor with nitroprusside?
BP
what can taking nitroprusside long term lead to?
cyandide toxicity
which meds are given for inotropic support for HF? (3)
dobutamine
dopamine
milrinone
describe the dosing difference of dopamine
mid-dose increases contractility
high-dose vasoconstricts and increases afterload
the nurse is caring for an acute exacerbation of HF, which of the following should the nurse anticipate?
a) metoprolol
b) 0.9% NS bolus
c) morphine
d) dobutamine
d) dobutamine (+ inotrope)
what is an abdominal aortic aneurysm?
localized dilation of a portion of the aorta >1.5x its normal diameter (usually at a weakened point)
risk factors for abdominal aortic aneurysm (AAA)
smoking
age
HTN
lipid disorders
atherosclerosis
genetic predisposition
what syndrome has a genetic predisposition for AAA
marfan syndrome
sx related to STABLE AAA
-palpable, pulsatile mass in umbilical area
-abd pain
-lower back pain
sx of acute rupture of AAA
-sudden onset of severe abd pain
-hypoTN w/ abrupt loss of consciousness
what is the management of AAA IF STABLE?
risk factor modification and elimination
what would qualify someone for aurgucal repair of AAA (3 things)
-aneurysm >4.5-5.5 cm
-rapidly expanding
-symptomatic regardless of size
what is aortic dissection?
-weakened aortic medial layers
-false channel/lumen is created as blood is pumped through tear
-classified based on location
which location of aortic dissection is most severe?
proximal (type A)
sx of acute aortic dissection
-severe/sudden HTN (200s)
-excruciating pain in the back between shoulder blades
-RIPPING/TEARING SNESATION in chest
-UNEQUAL PULSES
medical management if aortic dissection
BP reduction: beta blockers, IV vasodilators like nitroprusside
pain relief/sedation
post op management of aortic dissection
IV nitroprusside to KEEP BP UNDER 120
monitor cardiac rhythm, hemodynamics, output (chest tube), temp, neuro assessment
complications from aortic dissection surgery
stem from bypass effects (dec. perfusion on bypass)
-acute renal failure
-ischemic colitis
-spinal cord ischemia
labs to monitor after aortic dissection surgical repair
-creatinine/BUN
-hgb/hct
-platelets (thrombocytopenia)
-WBC & differential
-electrolytes
what disease obstructs blood supply of upper/lower extremities
peripheral arterial disease
risk factors for PAD
atherosclerosis
smoking
diabetes
age >70
males
HTN
hyperlipids
family hx
signs/manifestations of PAD
5 P’s
Pain intermittent claudication
pulselessness
pallor
paresthesia
paralysis
what is pain from in PAD
intermittent claudication
how much is occluded in intermittent claudication
> 75% of the vessel
what does early intermittent claudication feel like?
cramping, burning, aching pain in legs/buttocks with activity that is relieved by rest
what does late intermittent claudication feel like?
pain at rest is a warning sign of anoxic limb
describe rating scale for pulse strength
0- absent
1- palpable, thready, weak, easily obliterated
2- normal, not easily obliterated
3- full, bounding, easily palpable, cannot obliterate
what does lower extremity skin look like with PAD?
-cool, atrophic, shiny
-alopecia
-reddened
-pale upon elevation
-thick, brittle nails
-ulcers/lesions non-healing
what do paralysis and paresthesias suggest?
limb threatening ischemia and mandate emergent evaluation and consultation
describe ankle brachial index (ABI)
-apply blood pressure cuff to upper arm and above ankle and obtain BP readings
-systolic ankle pressure is divided by systolic brachial pressure
medical management of PAD
-modify/eliminate risk factors
-meds (anti-thrombotics)
-lipid lowering drugd
-stenting
-surgical vascular bypass for severe obstruction
what does chronic venous insuffiency look like
-brown pigmentation of skin
-edema
-thick, flaky skin
-ulcerations
nurse is caring for post aortic dissection repair with vitals 189/102, 98bpm, RR 20, 98 F, SpO2 99. what is priority action?
a) draw CBC
b) start nitroprusside to keep BP <120
c) start norepi to keep BP >130
d) assess urine output
b
which med is for PAD?
a) clopidogrel
b) tenecteplase (TNK)
c) norepi
d) nitroprusside
a
