Cardiology Flashcards
Hypertension Pathophysiology
The amount of resistance of blood pumping through the body/arteries
Hypertension is known as the silent killer, when a patient starts to have signs and symptoms with hypertension, major organs have already been affected
Organs Involved in Hypertension
CAKE
Cardiac system: congestive HF due to the overworking of the heart which makes it become enlarged
brAin: Stroke (increased pressure weakens blood vessels which can cause a clot to form or for them to rupture
Kidneys: renal failure (weakens and narrows the arteries to the kidneys and the kidneys dont receive proper perfusion)
Eyes: visual changes, Blurred vision
Normal Blood Pressure
120/80
Prehypertension
120-139/80-89
Stage 1 Hypertension
140-159/90-99
Stage 2 Hypertension
160/>100
Hypertension Crisis
Over 180/130
Emergency Crisis, can destroy vital organs
Give IV drugs immediately
Beta Blockers: Blocks beats slows heart
C: CCBs Clams the heart
D: Dilators (vasodilators) Nitro - decreased BP
E: ER to ICU
Hypertension Complications
AABC
Atherosclerosis (scarred, hard arteries)
Aneurysm: (popping blood vessels)
Broken Kidneys (Eyes and Heart Failure)
Renal failure
Retinopathy “blind”
Neuropathy
Heart Failure
Clots
Lung = PE
Brain = CVA stroke
Heart = MI
Hypertension Causes
‘SODA’
Stress: smoking, sedentary lifestyle, stimulants
Obesity, Oral contraceptives
Diet (High sodium and Cholesterol), Diseases + Dr. HH
Diabetes, renal disease, heart failure, hyperlipidemia (over 200)
A: African men and Age
Diagnostic Imaging Tests Hypertension
Chest Xray
Echo
ECG: Tall R peaks
3 BPs 1 week apart is what a doctor needs to diagnose hypertension
looking for:
Enlarged Left ventricle
Left ventrical hypertrophy
Diagnostic Lab Tests for Hypertension
BNP (bulging ventricles)
C-Reactivie Protein
Cholesterol Panel (Clogged Arteries)
Cholesterol Panel
Cholesterol Panel (Clogged Arteries)
Total cholesterol = 200 or less
triglycerides = 150 or less
LDL = 100 or less
HDL = 40 or more
(fruits and veggies do not add cholesterol to the body, animal products clog arteries)
BNP
BNP (bulging ventricles)
100 & less = normal
300+ Mild
600+ Moderate
900+ Severe
C-Reactivie Protein
Shows total body inflammation
Ejection fraction
Amount of blood being pumped out of left ventricle
55% -70% is normal
40%. or less is BAD
Secondary Hypertension
Caused by a pre-existing issue, there is something causing the person to have high blood pressure
Pregnancy
Cushing syndrome
Chronic Renal failure
Diabetes
Hypo/hyperthyroidism
Symptoms of Hypertension
Silent killer, most likely no symptoms
Most common symptoms:
Headache
Blurry vision
Chest pain
Nose bleeds
Ringing in the ears
Dizzy
Nursing Interventions For Hypertension
Measure BP in both arms
Evaluate dietary intake, body mass index
Educate: limit sodium. alcohol and caffeine diet, quiet smoking (vasoconstriction), start exercising (cardiovascular) for weight loss, medication compliance, monitor BP
Education for Hypertension
Educate: limit sodium. alcohol and caffeine diet, quiet smoking (vasoconstriction), start exercising (cardiovascular) for weight loss, medication compliance, monitor BP
Hypertension Treatments
DRESS
Diet (low sodium, calories, cholesterol)
Reduce alcohol and Caffeine intake
Exercise: Walking (30min x5 days/week)
Stop smoking and Alcohol
Stress Reduction
Hypertension Pharmacology
ACE Inhibitors
ACE inhibitors: end in PRIL think chill pril
Clam Low BP or HR (decrease)
Side effects think ACE:
Angioedema
Cough
Electrolyte imbalances (low sodium, high potassium)
Hypertension Pharmacology
ARBS
Lowers BP
LoSARTAN (relaxed man)
less workload on the heart and more relaxation to the blood pressure
lets fluid out, decreases BP
Hypertension Pharmacology
Beta Blockers
Blocks Beats, breaks on the heart (slows the heart)
Ends in LOL
Atenolol, labetalol
L = Lowers
Caution before giving beta blockers
4 B’s
Bradycardia (60 or less)
Bottomed out BP (80/60)
Breathing problems (COPD, asthma)
Blood sugar masking (diabetes)
Hypertension Pharmacology
Calcium Channel Blockers
Calcium Channel Blockers
Clams the Heart, Controls the BP
Niphedipine (PINE rhymes with break TIME, calms the heart)
Cardizem (ZEM, think ZEN = Clam)
Verapamil (mil = chill)
Hypertension Pharmacology
Diuretics
Diuretics
Decrease BP
Drain Fluid (urinate)
Dehydrate (dried body)
Potassium sparing Diuretics
Potassium sparing
(caution: Avoid potassium)
S - SpironolACTONE
S- Spares potassium
Blocks aldosterone
Avoid salt substitutes
Potassium wasting Diuretics
K+ wasting
(caution: hypokalemia 3.5 or less)
FurosemIDE
HydrochlorathiazIDE
DrIED
*only give potassium wasters if potassium is normal (3.5-5.0)
* not isorbIDE (nitrate used for chest pain)
Eat foods high in potassium
Hypertension Pharmacology
Dilators
Dilators decrease BP by dilating the blood vessels
D: Decrease BP
D: Dilates Vessels
D: Decrease vascular Resistance
Nitro = pillow for the heart
Never give if a patient is on viagra or erectile drugs - significant drop in BP will kill pt ex. Sildenafil
Pharmacology
Anti platelet and Cholesterol
Help to prevent clots and help with plaque build up in the arteries
Anti Platelet
ASA
Clopidogrel (plavix)
Caution: Bleeding
Cholesterol Lowering
lovaSTATIN “stay clean” cleans out arteries
Caution: Liver Toxic, no grape fruit
Coronary Artery Disease Pathophysiology
coronary arteries deliver a constant supply of blood to the heart muscle
begin to develop fatty plaques that can lead to restriction of blood flow to the heart
Fatty plaques are caused by a condition called ATHEROSCLEROSIS
Happens overtime
Limits blood supply to the heart muscle and can rupture which can lead to thrombosis formation (hence causing a myocardial infarction)
Atherosclerosis can also lead to hypertension, chest pain, and heart failure.
Atherosclerosis Pathophysiology
Build up of plaque on the artery walls
asymptomatic until the plaque becomes so big the artery starts to become narrow and blood flow to the heart becomes restricted.
The patient can experience stable angina
but the patient only has the chest pain during ACTIVITY.
The activity increases the heart rate and puts strain on the heart which already has compromised blood flow, but when the activity STOPS the pain STOPS too.
Collateral circulation
This can develop if chronic ischemia is experienced. This is where more than one artery forms to re-route blood to the heart muscle to make up for the decreased blood flow due to the blockage.
Left Coronary artery
The left main coronary artery supplies blood to the left side of the heart (left ventricle and left atrium)
Right Coronary Artery
Right coronary artery provides blood to the right atrium and ventricle and the SA (sinoatrial) and AV (atrioventricular) nodes which regulatethe heart rhythym.
The right coronary artery divides into smaller branches including the
Right posterior descendng artery
Acute marginal atery
Factors that increase astherosclerosis
Smoking
Unhealthy: obese or overweight
High cholesterol
Sedentary lifestyle
Diabetes
Family history
Signs and Symptoms Coronary Artery Disease
Chest pain
Shortness of Breath
Fatigue
How is Coronary Artery Disease Diagnosed
Blood test: Lipoprotein profile: total cholesterol, LDL, HDL, triglycerides
Stress test: monitor the heart rate and rhythm during exercise and see if there are any EKG changes
Heart Cath: a special catheter is inserted into the femoral or radial artery to assess for blockages in the artery. Dye is injected into the coronary arteries to assess if they are blocked (coronary angiography)…moderate sedation is used and the patient breathes on their own.
Treatment Coronary Artery Disease
Cardiac doctor makes the decision if the artery needs:
PCI (also called angioplasty): Percutaneous Coronary Intervention
Balloon angioplasty: inflates a balloon in the blocked artery to compress the plaque against the artery wall and a stent is placed to allow blood to flow back through the artery.
Atherectomy: removal of plaque from the artery
Nursing Interventions Coronary Artery Disease
Educate the patient about the significance and complications of CAD
Modifying lifestyle:
How to manage with diet (low fat, low calorie)
Exercise program
Smoking cessation and why it is important
Weight loss
Monitoring heart rate and blood pressure
Signs and symptoms and when to seek help
Stable Angina
Pain during exercise or stress
Stable (chronic) angina is the most common type of angina
Usallyuindicates 70% of the artery is blocked by plaque build up
Chest pain during times of exertion or emotional stress because the body needs more blood then the artery can supply
Pain usually goes away with rest
Cause of Stable Angina
Reduced blood flow which causes ischemia (lack of blood flow and oxygen) to the heart, almost like the heart is being strangled which causes terrible chest pain
Underlying cause of stable angina is atherosclerosis of one or more of the coronary arteries
What are the 3 layers of the Heart
Epicardium (outermost)
Myocardium (middle)
Endocardium (inside heart)
Unstable Angina
Chest pain during exercise or rest aswell as at REST, doesn’t go away
Emergency: High risk of progressive to MI (heart attack)
Unstable angina = heart tissue is alive but ischemic (starving for oxygen and blood)
Myocardial Infarction = tissues have already began too necrose or die
Cause of Unstable Angina
Caused by rupture or astheroscerlotic plaque or thrombosis (blood clot forms on top of plaque)
Although the occlusion might not block the entire vessel there is now even less room for blood to flow by and the heart tissue is starting to feel starved for oxygen even while pumping at a normal rate
Angina Treatment
Nitroglycerin is typically given to open up coronary artery
Pill or Spray: Stable angina - take before strenuous activity
Call 911 if there is still pain after 1st dose
3 doses max 5 min apart
No swallowing: Sublingual
Keep in dark original container, avoid light and heat, replace every 6 months
Nitro patch: Unstable angina, can happen at anytime
Apply 1 time per day not PRN
Never use two patches
Patches are shower safe
Rotate locations daily.
Clean, dry, shaven area
If patch falls off: (over 1 hour ago) take pill/spray, patch can take 40-60min to work
Nurses - always wear gloves, very potent to the skin
Acute coronary syndrome
Describes a range of conditions related to sudden, reduced blood flow to the heart.
These conditions include a heart attack and unstable angina
Causes of Acute Coronary Syndrome (MI)
SODDA
Stress, stimulants (caffeine, amphetamines) Smoking
Obesity (BMI over 25)
Diabetes and Hypertension (140/90)
Diet High cholesterol
African American male
Age (over 50)
Men more common than women
Myocardial Infarction Pathophysiology
Heart need oxygen to pump, during an MI there is a blockage in the coronary arteries so the heart muscle suffocates to death
500 cells die per minute, if blocked over 45 minutes these cells can die permanently called necrosis
Narrowing and blockage is called by plaque build up (CAD, Atherosclerosis)
Troponin
when the heart dies it releases enzymes called Troponin
#1 Indicator of an MI
Trop over 0.5 indicates trauma to the heart. when the heart muscle dies This protein leaks out into the blood along with potassium so patients will also have high potassium
Ischemic Heart Disease
Disease causing low oxygen to the heart.
Can start as
Coronary Artery Disease, Stable Angina (chest pain)
and progress to Acute Coronary Syndrome which encompasses unstable angina and MI
MI Signs and Symptoms
Key Words:
Chest pain: “sudden, Crushing, radiating, heavy pressure”
Pain:
Substernal Chest pain
Jaw pain
Left arm
Mid back/shoulder pain
Heartburn (epigastric pain)
SOB: Dyspnea, laboured breathing
Nausea Vomiting “abdominal pain”
Sweating: Diaphoresis
Pale cool skin “dusky”
Anxiety
MI in diabetics and Women often go unnoticed
MI Diagnostic Tests
Any new chest pain always requires an EKG first
ST elevation:
if ST is high then heart muscles have died
if ST is low we think low O2
ST depression (low O2) T wave inversion caused by low O2 or ischemia, meaning only partial blockage or it could be hypokalemia
ST segments usually go back to normal when we get reperfusion
Treatment for MI
Goal is to unclog the coronary artery within 45 minutes, patients are taken to the Cath lab immediately to locate and fix the blockages we call it the ABCs of MI surgery
Angioplasty: PCI used to visualize and move aside the blockages with either ballon for stent
Bypass CABG: goes around more severe blockages using piece of vein or artery from another part of the body usually the leg
Cut out the fatty Blockage - Endarterectomy
Thrombolytics for MI
use thrombolytics AKA clot blusters if surgery is not immediately available
TPA (amionolase) or Streptokinase usually not routinely given as first-line since they can cause massive bleeding
have to be given two to six hours of initial MI
Bleeding Risk 8 hour window
no injections (IV, SQ, IM, ABG)
Not given through central line
Negative Troponin
Non MI
Different test to diagnose the narrowing
Stress test seeing how it does with low oxygen, done to help pinpoint potential blockages so two types of stress tests are given
Stress Test
Different test to diagnose the narrowing
Stress test seeing how heart does with low oxygen
done to help pinpoint potential blockages so two types of stress tests are given
Exercise or treadmill stress test: looking for ST changes
ALWAYS Stop for chest pain or ST changes
Non Exercise called nuclear pharmacological: radioactive dye is injected into the vessels acting like a highlighter to pinpoint potential blockages
*teach the patient to avoid meds and stimulants that can alter the test
24-48 hours before: Avoid cigarettes and caffeine: tea, soda, coffee NO DECAF
Avoid Meds: Nitro, beta blockers
Theophyline (stimulant causing narrowing)
Not eating for drinking 4 hours before and after the test
MI Treatment
OANM
Oxygen
Aspirin
Nitro
Morphine: helps heart to relax
* any chest pain after morphine indicates MI
More pain = more tissue death
MI treatment NEXT
Next: Clot
Cath lab (PCI - percutaneous coronary Intervention) or one of thre treatment procedures, balloon, bypass etc.
Clot buster: TPA to dissolve the clot
Fibrinolytics AKA clot busters one time push drugs
MI Treatment AFTER
After: Rest and Prevent Clots
Prevent/stabilize clots
Heparin IV: heparin does not dissolve clots, only clot busters dissolve clots (TPA)
Prevent clots by thinning the blood, huge bleed risk
Therapeutic range for coagulation therapy
PTT 46-70 (standard is 3x max range)
Antidote: protamine sulfate
Heart Rest:
Nitro IV Drip
Beta blocker
CCB
avoid high sodium foods
MI Complications
Acute:
Cardiogenic Shock: Severe low BP
Dysrhythmias (V-fib/V-tach)
Chronic:
Heart Failure
Other Complications
Pericarditis
Mitral Valve Prolapse
Pericarditis
The inflammation to the sacs around the heart can lead to deadly pericardial effusion or cardiac tamponade
Priority S/S Remember BEC
B: Big JVD
E: extremely low BP
C: Cant hear heart sound (muffled or distant)
Cardiac tamponade
Heart squished to death by its own blood sac causing the heart to stop beating
Mitral Valve Prolapse
The little cords holding the valves can suddenly snap loose from a dead heart muscle
patients will have a heart murmur and even develop atrial fibrillation from blood backing up stretching out those atria
Heart Failure
Heart Failure: Think heavy fluid.
The Heart fails to pump blood forward and now backs up into the lungs and our body eventually drowning the patient.
HF results from a dysfunctional pump that causes fluid to back up
As a result of less cardiac output and less O2 circulating the body the kidneys get less blood low and think that the body has low blood pressure (low blood volume)
The body then mistakenly increased the already high blood volume by stimulating the sympathetic nervous system too increased the HR and constrict the blood vessels
RAAS System
(reinin angiosensin Aldosterone System)
HF activates the RAAS system which retains fluid. by locking the kidneys and constricting the blood vessels no now there are two problems
1. Already weak pump with increasingly high blood volume high blood pressure
2. Increased fluid and fluid unable to be excreted
*to fix this give drugs that block or cut the communication lines to aldosterone
prills, sartre, actone ending drugs
Aldosterone Hormone
Adds sodium and water to the body which increases blood pressure and let’s potassium out of the body. Without aldosterone we lose too much water and have too much potassium in the body
Drugs That Increase Potassium
Leading to high. potassium over 5.0
Lisinopril (ACE)
LoSartan (ARBs)
Spironolactone (Diuretic)
Indicators of HF
Always Report:
Rapid weight gain
Worsening crackles
Sudden Edema/JVD
New S3 heart sounds or murmurs
Causes of Right sided HF
Left sided HF can cause Right sided HF
pulmonary Hypertension
Disease of lungs like COPD
Distructive sleep apnea
Right sided HF
Rocks the body with fluid
“Peripheral Edema”
Weight Gain = Water gain
Over 3 lbs in 1 day or 5 lbs in 7 days is very bad
Edema (pitting)
JVD
Abdominal growth: Ascities, hepatomegaly (big liver), Splenomegaly (big spleen)
Left Sided HF
Think L for lungs
Lungs build up with fluid
“Pulmonary Edema”
More serious affects ABCS
Crackles “rales” (not rhonci or wheezes)
Frothy pink - blood tinged sputum
Dyspnea
Orthopnea
Causes Left Sided HF
Damage to the myocardial heart muscle, making the heart weak = weaker pump, usually from MI or ischemic heart disease
CHF Treatments
1 IDE ending drugs
Furosemide
Bumetanide
“HOPE”
H - HOB 45% semi or high fowlers
O - Oxygen
P - Push Furosemide + morphine (morphine decreased workload on the heart).
E - Ending all sodium and fluids, no drinking fluids, stopping IV fluids
How does the Nurse know the treatment for HF is successful?
Clear lung sounds
Decreased HR
Nclex TIP HF
Always question DR. order that wants to give fluids even maintenance fluids for worsening HF
Always reassess pt if being transferred to another floor
Sodium swells body - nothing from a package, not salad dressings, sauces, meats, cheeses. Nothing over the counter, no Tylenol for cold and flue meds
Diagnostic Test for HF
BNP
B-type Natriuretic Peptides
Echocardiography
Hemodynamic Monitioring
“Swans Ganz Cath” : measures CVP central venous pressure
(Normal 2-8)
Over 8 = BAD
Lifestyle Changes HF
Diet: Low sodium and Fluid 2L or less, 2g off salt or less
No canned or packaged foods
No OTC meds (cold and flu, acetaminophen, antacids, NSAIDs)
Risk for falls (change position slowly)
BP and BNP (should NOT be increasing)’Elevate legs (with. pillows). high fowlers
DAILY WEIGHTS (3lbs/day or 5lbs/7 days = worsening)
Sex (2 flights of stairs with no SOB)
Stockings. (decrease blood pooling, remove daily) Never massage calves of CHF patients
Nclex Tips HF
HF = heart failure = heavy fluid
Sodium = Swells
Patient with HF who his constipated. What would the nurse recommend?
Walking
Increase Fibre
Stool Softeners
NO drinking extra water!!!
A client with chronic HF took cold medication for her flu. She presents with new productive cough with pink frothy sputum and worsening crackles. What action should the nurse take first?
Give Bumetanide IV push
Infective Endocarditis
Inflammation of the inner lining of the heart, mainly the chambers and the valves
Infective indicates caused by bacteria or fungi
Inflammation more common on left side of heart where aortic and mitral valve are (bicuspid valve)
Endocarditis Pathophysiology
Three main layers of the heart
Epicardium: outer layer that protects the heart
Myocardium: muscle layer inside the heart
Endocardium: Inner layer where blood gets pushed around (this layer gets inflamed during endocarditis)
Bacteria builds up around valves and grows bigger and bigger eventually clogging the valve doors in the heart which impairs pumping = less cardiac output = less oxygen to the body.
Can be heard in a swooshing heart sound
Endocarditis Signs and Symptoms
Inflammation = Murmurs and clots
Infectious mold (bacteria, viral or fungal) = fever
Low cardiac output = low oxygen, could lead to HF
Lung fluid heard as crackles and spleen enlarged due to infection
Very Specific and Classic Symptoms:
Splinter Hemorrhages (finger nails)
Oslers Nodes (hands)
Roth Spots (eyes)
Janeway Lesions
Symptoms due to low oxygen
Fatigue
Pain in the chest when breathing
Clubbing of fingers (hypoxia)
Anorexia and weight loss
Petechiae (red bumps)
What bacteria is Infective Endocarditis Caused by
Staphylococcus
Steptococci
These can start as strep throat and move into the lungs and heart causing pneumonia and endocarditis leading to death
Complication of Infection Endocarditis
Stroke, caused by piece of mold that breaks off and clogs the arteries of the brain
Embolic CBA
Monitor for changes of LOC
confusion, agitation
Causes of Endocarditis
IV drug and dirty needles
Valve replacement surgery
Dental Visits
3 Types of Cardiomyopathy
3 different types of cardiomyopathy
Dilated: Distended heart muscle
Restrictive: Rock hard heart muscle
Hypertrophic: Huge heart muscle
Cardiomyopathy
Disease of the Heart Muscle
(myocardium) which inhibits effective pumping
pump failure = less cardiac output = less oxygen to the body
Dilated Cardiomyopathy
Most common
Distended heart muscle
Heart muscle being stretched = lose valves so they don’t close all the way = weak squeeze for systolic pressure = pump failure
Blood will back up into the lungs
Signs and symptoms are similar to HF
Low O2, syncope and ALOC, narrow pulse pressure (numbers are closer together, S3 Murmur
Treatment for Dilated Cardiomyopathy
Increase Cardiac output which will increase O2 into the body
These meds clam the heart and lower BP and heart rate
Ace inhibitors: Drop BP
Beta Blockers: Slow HR
Calcium Channel Blockers: Decreases BP, lowers HR
Digoxin: Deep contraction, slows HR, hold med if apical pulse less than 60, check potassium levels., monitor for toxicity over 2.0 (vision changes are first sign of toxicity)
Diuretics: Decreases BP by removing fluid from the body, potassium wasting (keep potassium intake high)
If medications do not fix condition, surgery is the next fix
LVAD (left ventricular assist device) helps the ventricle pump
Heart Transplant
Restrictive Cardiomyopathy
Heart muscles thick and stiff, hard like a rock. Stops ventricles from stretching making it hard to refill.
Less blood in
Less cardiac output = less oxygen to the body
pump failure
Signs and Symptoms similar to HF
Causes of Restrictive Cardiomyopathy
Genetics
Damage - from radiation
Treatment Restrictive Cardiomyopathy
Decrease radiation exposure
Heart Transplant
Hypertrophic Cardiomyopathy
Thick, huge heart
Septum enlarged limits the heart from filling
Less blood in
Less cardiac output
Less oxygen out to the body
The heart muscle starts to grow and obstructs the aortic valve blocking all the Oxygenated blood going out to the body, happens during exercise (sudden strain) = sudden death in a matter of minutes
Hypertrophic Cardiomyopathy Causes
No signs and symptoms and is usually undiagnosed
Common in young active children
Deadly
Diagnosed early in child hood
Only Cause is Genetic
Hypertrophic Cardiomyopathy
Heart Murmur detection, systolic ejection murmur
pt will be asked to bare down as Dr. listens to the heart
Echo will show septal wall thickening
Treatment Hypertrophic Cardiomyopathy
Surgery is the best option
if on medications:
Only give beta blocker and calcium channel blockers
Never give
Dilators (nitro)
Digoxin
Diuretics
Patient education hypertrophic cardiomyopathy
Avoid (deadly)
Heavy lifting (bearing down to poop)
Burst of activity (sprints)
Sudden position changes
Pericarditis
Inflammation of the fibrous sac surrounding the heart
pericardium = layer around the heart
Acute pericarditis = lasts several weeks
Chronic pericarditis = lasts over 6 months (constructive pericarditis) sac around the heart becomes thick and hard
Can lead too pericardial effusion, cardiac tamponade
Peripheral Arterial Disease
Narrow arteries oxygen can’t get down to the distal extremities fingers and toes
Oxygen problem, narrow arteries making the pumping off oxygen away from heart difficult = ischemia and narcosis
Cold legs and weak pulses
Sharp calf pain
Treatment of Peripheral Arterial Disease
Hang leg over the bed, helps blood flow
Signs and Symptoms Peripheral Arterial Disease
Signs and Symptoms
Absent of pulses and air (shiny) cool legs
Round red sores
Pale toes and feet, Black Eschar
Sharp calf pain during exercise or elevation
Intermittent claudication = calf pain = warning sign for low oxygen
Causes of Peripheral Arterial Disease and Venous Disease
Causes:
smoking
Diabetes
High cholesterol
High BP
PAD teaching
No heating pads
Dont elevate legs
Swelling of legs is not expected
Peripheral venous disease
Narrow veins
Veins bring oxygen back to the heart
= problem brining blood back to the heart
= blood pools in the leg
Not an oxygen problem
Sign and Symptoms
Voluptuous pulses = warm legs
Edema where blood starts pooling
Irregular shaped sores (exotic pooling)
No sharp pain, dull pain
Yellow and brown ankles
Signs and Symptoms Peripheral venous disease
Sign and Symptoms
Voluptuous pulses = warm legs
Edema where blood starts pooling
Irredgular shaped sores (exotic pooling)
No sharp pain, dull pain
Yellow and brown ankles
Treatment Peripheral venous disease
Treatment
Veins = Elevate limbs helps bring blood back to heart
6 P’s
6 P’s = O2 assessment
Pain: unrelieved at rest
Parasthesia: numbness and tingling
Prioritization = oxygen problem
Pulses: diminished weak
pallor: Pale
Polar: Cold
Paralysis: inability to move limb
Aortic Aneurysm
a balloon-like bulge in the aorta
the large artery that carries blood from the heart through the chest and torso.
Aortic aneurysms can dissect or rupture
Central Venous Pressure
Normal 2-8
Above 8 = fluid overload, right ventricular failure
What can occur if furosemide is given too fast
Titunits
How to assess mechanical capture of new pacemaker
Count Clients HR
Where is Bruit heard
Bruit is turblent blood flow
Blood flowing througha narrwed Artery
Left to right Heart Shunt Paediatric
Symptoms associated with HF
Crackles
Heart murmur
Decreased urinary output
Diaphoresis during feedings
SOB
What does a straight line noted prior to each p wave indicate
Atrial paced rhythm
Intermittent Claudication
Pain affecting the calf that is induced by exercise and relieved by rest
What should you do before a cardio- version
PTT levels and ECHO
Tetralogy of Fallot
Combination of 4 heart defects present at birth
Oxygen poor blood to flow out of heart and into the rest of the body
Cyanosis when crying = put infant in knee to chest position, helps improve oxygenation
What medication is contraindicated for patients experiencing worsening HF
Carvedilol
How do salt substitutes affect potassium
Maintain adequate potassium
