Cardiac/resp Flashcards
Heart disease
Term to describe several types of cardiac conditions (arryhtmias, congenital, and heart valve d/s)
Most common CAD
Risk factors: smoking, inactivity, increased BP, DMII
Cardiac intervention
Educating/training on modifiable lifestyle factors, exercise, medication use
Thrombolysis
Procedure involving injecting clot dissolving agent, need to be within 30 minutes of pt arrival
Coronary angioplasty
PCI, balloon angioplasty ,coronary artery balloon dilation, tubing with deflated balloon threaded through artery, balloon inflated to widen block areas, can be combined with stent
Increase blood flow, decreased angina, increased ability for physical activity, used at neck/brain to prevent stroke
Laser angioplasty
Catheter has a laser tip that opens blocked artery, pulsating beams of light vaporize blocked artery to increase blood flow
Heart Valve Replacement
Repairs/replaces abnormal/diseased heart valve with a healthy one
Atherectomy
Similar to angioplasty except that catheter has rotating shaver on tip to cut away plaque
Increased blood flow, used at carotid arteries to reduce strength
CABG
Takes arteries/veins from other parts of body (graft) to reroute blood around clogged artery
Effective/common tx to tx blockages to increase blood supply and O2 to heart, relieves angina, decreases risk of heart attack, increased ability for physical activity
Heart transplant
Removes disease heart and replaces with healthy heart when damage is irreversible, need organ donor
Minimal invasive heart sx
Limited access Coronary arteries sx
Post-access coronary artery bypass (PA CAB/portcab)
Minimally invasive CABG (MidCab)
Alternative to CABG, small incision at chest, arteries from
Chest/leg are attached to heart, instruments passed through ports
Manages blockage of bloodflow, increased blood supply and O2, relieves chest pain, reduces risk of heart attack, increases ability for physical activity
Radiofrequency ablation
Catheter ablation, electrode guided through veins to heart muscle with real-team, moving xray, painless radiofrequency energy transmitted to destroy heart cells in small area
Preferred tx for arrythmias
Stent placement
Wire mesh tub used to hold open artery during angioplasty, restenosis is narrowing after stent
Hold artery open to increase blood flow and decreased angina
Transmyocardial revascularization
TMR, incision made on L breast yo expose heart, laser used to create a series of wholes
Relieves angina, increase risk of heart attack, unable to be revascularized by CABG alone
Anticoagulants
Blood thinner, decreased clotting, do not dissolve existing blood clots, used to tx blood vessel, heart, and lung conditions, prevents clots from getting bigger
Apixaban (eliquis), dabigatran (pradaxa), edoxabon (savaysa), heparin, rivaroxaban (xarelto), warfarin (coumadin)
Antiplatelet and dual antiplatelet therapy (DAPT)
Keeps blood clots from forming by preventing blood platelets from sticking together, prevents clotting in people with heart attacks, unstable angina, ischemic strokes
Used preventively for plaque build up
Aspirin, clopidogrel (plavix), dipyridamole, prasugrel, ticagrelor, daul-lis aspirin
Angiotensin converting enzyme (ACE) inhibitor
Reduces BP by widening blood vessel to reduce work load of heart, used to tx symptoms of htn and heart failure
Benzapril, captopril, enalapril, fosinopril, lisonoptil, moexipril, perindopril, quinapril, ramipril, trandolapril
Angiotensin II receptor blocker/inhibitors
ARBS, prevent angiotensin II from having effect on heart/blood vessels, keeps BP from elevating
Used to tx symptoms of heart failure/htn
Azilsartan, candesartan, eprosartan, irbesartab, losartan, olmesartan, telmisartan, valsartan
Angiotensin Receptir-Neprilysin inhibitor (ARNI)
Combo of ARB and neprilysin inhibitor
Improve artery opening, blood flow and reduce salt retention, strain on heart, tx heart failure
Valsartan/sacubitril (entresto)
Beta-blockers
Slows heart rate and force of contraction to reduce BP, heart beats slower with less force
Txs heart attacks, htn, angina, used to prevent future heart attacks
Acebutolol, atenolol, betaxolol, bisoprolol/hydrochlorothiazide, bisoprolol, metoprolol, propranolol, sotalol
Combined alpha and beta blockers
Txs high BP and heart failure
Side effect is orthostatic hypotension
Carvedilol, labetalol, hydrochloride
Calcium channel blockers
Calcium antagonist/calcium blockers interrupt movement of calcium into cells of heart and blood vessels, reduce pumping strength, relaxes blood vessel
used for increased BP, chest pain, and arrythmias
Amlodipine, diltiazen, felodipine, nifedipine, nimodipine, nisoldipine, verapamil
Cholesterol lowering medications
Drugs other than statins are usually used for patients whom statins are ineffective or serious side effects
Reduces LDL cholesterol
Atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin
Nonstatins:
nicotonic acid (niacin)
Cholesterol absorption inhibitors (ezetimibe)
Diuretics
Cause body yo rid self of excess fluids and sodium through urination, reduces heart work load, fluid build
Up around lungs, lowers BO, reduces edema
Acetazolamide, amiloride, Bumetanide,chlorothiazide, chlorthalidone, furosemide, hydro-chlorothiazide, indapamide, metalozone, spironolactone, torsemide
Vasodilators
Dilates blood vessels to reduce BP and increase blood glow so heart doesnt work as hard
Nitrates=nitroglycerin, sublingual, spray, cream
Reduces angina, Bp, used to tx hypertension in pregnancy
Sternal precautions
4-12 weeks
Avoid pushing, pulling, lifting greater than 10 lbs, avoid weight into arms, don’t raise elbows above shoulder height, avoid reaching behind/twisting body
Conservative treatment for chronic respiratory conditions
Smoking cessation
Medications
Steroids
Pulmonary rehab programs
Bronchodilators
Inhalers
Supplemental O2
O2 therapy
Used to tx COPD, COVID19, emphysema, sleep apnea, asthma, bronchitis, cystic fibrosis, CHF, lung Ca, pulmonary fibrosis, pna
Air is 80%nitrogen and 20% oxygen
Healthy SPO2 is 95%; O2 therapy when below 88%
Low O2 can damage organs
Signs of hypoxia
SOB
bluish tint to skin, lips, nails
Extreme fatigue
Severe headaches
Coughing
Wheezing
Fast pulse/HR
Confusion
Types of O2 systems: compressed
Gas
Large cylinder stores 100% gas under pressure with regulator to control
Flow, O2 conserving device sends O2 when you inhale and stops when you exhale, eventually run out of O2
Types of O2 systems: liquid O2
Thermos like container stores pure O2 as very cold liquid, when you release O2 the liquid converts to gas makes it portable outside home
Types of O2: O2 concentrators
Pulls air from room, separates and compresses O2 from air while removing nitrogen, you breathe purified air, don’t run out of O2
Delivered nasal cannula, face masks, tracheotomy tube
O2 side effects and O2 risks
Side effects=epistaxis, headaches in AM, fatigue
O2 risks=don’t smoke near tanks, 5ft from flares, secure O2 tank upright to a stand, never roll a cylinder, may crack causing compression and explosion, 8ft from heat producing devices, not use flammable materials aerosol spray, choose cotton clothes to reduce static electricity sparks, have fire a fire extinguisher bearby
O2 poisoning
Too much oxygen, sx include chest pain, difficulty breathing, dizziness, muscle spasms, nausea, vision problems
Hyperbaric O2 treatment
Pressurized chamber yo deliver 100% pure O2 to lungs, increase pressure helps lungs take more O2
Can help heal wounds, burns, infections
Tx bends/decompression syndrome which is build up of nitrogen in blood/tissues
Assessment of resp/cardiac
Vitals/rate of exertion pre/post activity
Functional limitations
PE Risk (copd increases risk of PE, asses risk factors for increase risks)
Psychosocial needs of pt/caregivers (decrease QOL caring for chronic conditions)
Cognition delirium s/p sx, adherence to precautions, medical mgmt
Ability to follow restrictions
RPE
Borg rate of physical exertion
Original 6-20, revised 1-10
1-10 light
12-16 somewhat hard
17-20 hard
Revised 1 really easy, 2 easy, 3 moderate, 4 sort of hard, 5/6 hard, 7/8 really hard, 9 really really hard 10 maximal
Cardiac/respiratory intervention
Pt education
Exercise
Health management
Cardiac rehab
Pulmonary rehab
Cardiac/ respiratory tx: pt education
Symptom mgmt, dx, ECT, mind-body-self-care (sleephygiene, relaxation , nutrition, benefits of physical acitivty, strong support to improve sleep)
Diagnosis ed (moderate support)
ECT (conscious planning, balancing activity vs. rest, alternative working methods, breathing techniques),
Cardiac/respiratory intervention: exercise
Moderate support to increase ADLs, 1 hour of aerobic/resistance exercise 3x/week
Address barriers to exercise
Health management
-Symptom mgmt
-Ability to effectively manage chronic cardiac/respiratory conditions
-developing health and wellness routines
- self management: ability of individual to manage sx, tx, lifestyle changes, psychosocial/cultural/spiritual consequences (moderate support based in stanford model of chronic d/s self mgmt)
-precaution/medical intervention-obstaining from activities which exacerbates condition, med mgmt
-managing O2 during activity, self id orn needs
Keep you move in the tube 4-12 weeks sternal prec
Cardiac Rehab
Supports within areas of exercise, counseling, nutritional/lifestyle education, medically supervised program, classes, smoking cessation, healthy eating plan, increase fitness level, relaxation skills
36 one hour sessions = 47% decrease risk of death, 31% decrease in risk of MI, reduces re-admission
Pulmonary rehab
Supervised program that helps improve lung function and QOL, breathe better
For COPD, asthma, pulmonary htn, cystic fibrosis, scoliosis
Benefits gain strength, decrease anxiety/depression sx, easier to manage routine activities, work, social activities
90% spend fewer days in hospital
85% of copd pts develop anxiety
COPD
SOB, cough/sputum production, caused by smoking, forced expiratory volume during 1st to forced vital capacity ratio FEVI:FVC less than .7
COPD intervention
Action plan-stop light format
Smoking cessation
Nutrition(6-8 glasses of water, 4-6 small meals for diaphragm move more easily, limit sodium/simple
Carbs)
Breathing tech (PLB, diaphragmatic breathing, coordinate with activity)
Airway clearance technique (coughing techniques due to mucus)
ECT
O2 therapy
Pt advocacy and support groups
COPD stop light format
Green continue normal day activity/medication
Yellow/bad day prn meds
Red day call 911, urgent medical needa
COPD airway clearance coughing techniquea
Huffing- chin tilted up mouth open sitting upright take slow deep breaths, fill lung 3/4, hold 2-3seconds and forcefully but slowly exhale, moving mucus from small to larger airways follow with cough
Heart surgery follow up
Call MD with fever over 101 *
Swelling redness at incision
BP increases 140/90 or less than 90/60
HR less than 60 BPM or more than 100 BPM
Breathing changes
ADLs: wash incision/pat dry, track temp, hr, BP, incision appearance
Walk 4x/day
May resume sex when you feel
Okay maintaining precautions/protect incision
