Cardiovascular Flashcards
what is pericarditis
inflammation of the pericardium - the sac that encloses the heart
caused by infective organisms:
- bacteria
- virus
- fungi
chest pain the client experiences is causd by inflamed pericaridum rubbing against the myocardium
percarditis manifestations
sharp substernal chest pain
- often relieved by sitting upright and leaning forward
pain is worse when lying down in a supine position or when they cough
- pericardial rub is present
listen to pericardial rub by using the bell of the stethoscope over the left lateral sternal broder
- you’ll hear one systolic sound and 2 diastolic sounds
- scratchy, grating or squeaky sound
other findingds:
- fever
- sweating
- chills
- dysrthyhmias
cannot lie flat without severe chest pain or shortness of breath
percarditis diagnostic studies
studies and lab tests will be prescribed to monitor for:
leukocytosis
increased ESR
positive blood cultures that indicate that infection is present
positive antinuclear antibody
12 lead ECG and changes in ST segment elevation
echocardiogram
percarditis care pharmacological interventions
antiinflammatory:
- NSAIDs
- corticosteroids
antibtiotics - if symptpoms are caused by an infection
analgesics: pain relief
aspirin and anticoagulants should be AVOIDED
surgical intervention may be necessary
- emergency percardiocentesis will be performed if cardiac tamponade develops
cardiac tamponade
when extra fluid builds up in the space around the heart
percarditis management
manage pain and anxiety
position in semi-fowlers or high fowlers
administer analgesics
monitor for complications:
- dysrhythmias
- HR
auscultate BP carefully to detect pulsus paradoxus
- a sign of cardiac tamponade
ensure that percardiocentesis tray is ready
initially monitor for: resp status cardiovascular status renal status - every 1-2 hours
pulsus paradoxus
change in BP with inspiration
to obtain pulsus paradoxus:
- palpate BP and inflate cuff above systolic pressure
- then deflate the cuff gradually and note when sounds are present on expiration
- then note when sounds are audible on inspiration
- then subtract the inspiratory pressure from the expiratory
> 10mmHg is an indication of cardiac tamponade
what is infective endocarditis
infection of the:
- endocardium
- heart valves
- heart valve prosthesis
infective endocarditis risk factors
prosthetic heart valves
hospital acquired bacteremia
IV drug use
congenital heart disease
hemodialysis
rheumatic fever
infective endocarditis manifestations
new or worsesning systolic murmur
fever
chills
night sweats with source of infection
athralgia
- pain in one or more joints
myalgia
- pain in one or more muscles
fatigue
malaise
anorexia
neurologic symptoms if stroke due to embolus
petechiae of teh skin
splinter hemorrhages under nails
Oslers nodes
janeways lesions
Oslers nodes present with tenderness, while JAneway leasions do not
infective endocarditis diagnostic studies
health hx
evelated WBC
positive blood
elevated CRP and ESR
TEE can show vegetation on valve which indicates endocarditis
infective endocarditis care
IV antibitiocs
- administered typically for 6 weeks
- or until infection resolves
antipyretics used to control fever
O2 administered to prevent tissue hypoxia
surigcal intention may be necessary to replace the valve that doesn’t respond to antibiotics
infective endocarditis management
monitor response to antibiotics
arrange for long term venous access for Iv antibiotics like PICC
explain to client and family for long term IV antibiotic therapy
prophylactic antibiotics before dental work and other invasive procedures
report any:
- fever
- tachycardia
- dyspnea
- shortness of breath
what is rheumatic endocarditis/rheumatic fever
acute inflammation condition that can involve all layers of the heart
when RF becomes chronic
- results in scarring and valvular damage
- referred to as rheumatic heart disease
rheumatic endocarditis/rheumatic fever manifestations
streptococcal pharyngitis
- sore throat with tonsillar exudate
- swollen lymph nodes
- hedache
- fever
warm and swollen joints
- polyarthritir
- usually in elbows
- wrists
- knees
- ankles
high fever
chills
malaise
shortness of breath or chest pain
chorea
- emotional instablity
- muscle weakness with quick, jerky movements
- usually in the hands, face, feet
erythema margniatum
- ring like or snake-shaped rash on trunk or extremities
elevated temp up to 104 farenheit
rheumatic endocarditis/rheumatic fever diagnostic studies
increased ASO titer
increased ESR
positive throat culture for streptococci
increased WBC count
rheumatic endocarditis/rheumatic fever care pharmacological interventions
analgesics ordered for pain and inflammation
antibiotics
O2 to prevent tissue hypoxia
rheumatic endocarditis/rheumatic fever management
provide or reinforce education about all tests and treatment
instruct client to resume ADLs slowly and schedule rest periods
observe reaction to antibiotics
monitor adherence to meds
avoid exposure to people with upper resp infection
instruct to report symptoms of pharyngitis
- sudden sore throat
prevent falls
monitor for cardiac complications
what is mitral stenosis
mitral valve thickens and gets narrower
- blocking blood flow from the left atrium to left ventricle
mitral stenosis manifestations
in early mitral stenosis
- will present with a mild, asymptomatic heart murmur
in moderate to severe stenosis
- experience symptoms of left sided HF,
- due to blood backing up into lungs and decredased cardiac output
other:
- exertion
- cough
- orthopnea
- weakness
- fatigue
- palpitations
- weight gain due to fluid retention
also common on propping up on pillows to sleep or sleeping in a recliner
paroxysmal nocturnal dyspnea
- sudden waking due to shortness of breath
mitral stenosis diagnostic studies
physical exam
12 lead ECG showing ventricular enlargement
echocardiogram evaluating valve function
CT scan with contrast
cardiomegaly showing cardiac enlargement
mitral stenosis pharamcological interventions
diuretics
oxygen
ACE inhibitors
beta blockers
low sodium diet
exercise as tolerate
surgery may be necesssary to repair or replace the mitral valve in event of recurrent episodes of heart failure
mitral stenosis nanagement
similar care to HR
may require antibiotics BEFORE dental care or other invasive procedure
what i mitral valve regurgitations
when damaged mitral valve allows blood from left ventricle to flow back into the left atrium during ventricular systole
to handle backflow, the atrium and left ventricle will enlarge over time
most cases of MVR care caused by:
- MI
- RF
- IE
mitral valve regurgitation manifestation
orthopnea dyspnea fatigue weakness weight loss
chest pain
palpitations
high pitched, blowing murmur that may radiate to armpit
jugular vein distention
peripheral edema
hepatomegaly
mitral valve prolapse
leaflets of the mitral valve buckle back into the left ventricle during systole
mitral valve regurgitations diagnostic studies
med hx and physical exam
chest x ray
CBC
12 lead ECG
echocardiogram or TEE
cardiac catheterization
mitral valve regurgitation pharamacological interventions
prophylactic antibiotic therapy
sodium restriction
drug therapy to control HF
drug therapy to control dysrhythmias - beta blockers
drug therapy to prevent embolization - anticoagulants
mitral valve regurgitation management
stay hydrated
avoid caffeine and aclohol
exercise regularly
reduce stress
similar to care of HR
what is aortic stenosis
aortic vavlve narrows, obstructing blood flow from the left ventricle to the aorta ana drest of body
often leads to:
- left sided HF
- ventricular hypertrophy
- cardiomyopathy
aortic stenosis does increase with age
aortic stenosis manifestations
classic triad:
- dyspnea
- syncope
- angina
fatigue
palpitations
left sided HF
orthopnea
paroxysmal nocturnal dyspnea
crackles in lungs
systolic murmur
- loud murmur in early systole
- listen by using diaphragm of the scope with pt in supine
fourth heart sound
- sounds like a gallop, low frequency sound
- listen using bell pressed lightly on the skin of chest in supine position
aortic stenosis diagnostic studies
physical and med hx
chest X-ray
CBC
12 lead ECG
echocardiogram or TEE
cardic catheterization
surgery may be needed to repair the valve or to replace it for severe, recurrent episodes of HF
aortic stenosis management
very similar care of HR
if client had valve surgery:
- monitor for hypotension and dysrhythmias
- teach long term anticoagulant therapy
what is aortic insufficiency/regurgitation
occurs when blood flows back into the left ventricle during diastole
leads to overloading the ventricle and causing it to hypertrophy
blood overloads the left atrium and eventually the pulmonary system
aortic insufficiency/regurgitation manifestations
uncomfrtable awareness of heartbeat
palpitations
dyspnea with exertion
orthopnea
paroxysmal noctural dyspnea
cough
fatigue and syncope with exertion or emotion
anginal chest pain unrelieved by sublingual nitroglycerin
nail beds appear to pulsating
Quinckes sign
- when you press down the nail tip, the root of your nail will show that it is pulsating
high pitched diastolic murmur at the third or fourth intercostal space, left sternal border
widened pulse pressure
pulsus bisferience
- double beat pulse
- palpated over the carotid or brachial artery
aortic insufficiency/regurgitation management
similar care to HF
if client had valve surgery, monitor for hypotension and dysrhythmias
factors affecting myocardial infarction mortality
timeliness of activating emergency response system
initation of CPR including use of an AED
number and location of occluded coronary vessels
previous MI
presence of cardiogenic shock adnvaced age
gender: females have higher mortality
myocardial infarction manifestations
persistent, crushing, substernal chest pain
pain may radiate to left arm, jaw, neck nd shoulder blader
feeling of impending doom that will not resolve with rest
clues that suggest “ilent” MI
HF change in mental status unexplained abdominal pain dyspnea fatigue
myocardial infarction diagnostic studies
serum cardiac markers will be elevated
CK-MB rises in 4-6 degreees within 3-6 hours
- peaks in 18-24 hours
LDH appears in 12-24 hours
- peaks in 48-72 hours
- lasts 6-12 days
troponin peaks 4-12 hours
- remaines elevated for up to 3 weeks
myocardial infarction pharmacological interventions
MONA
assess vital
12 led ECG
time is muscle so resolve symptoms quickly
enforce bedrest with bathroom priveleges
- activity should be slowly increased as long as client remains hemodynamically stable and free of chest pain
administer:
-antiplatelet/anticoagulants
nitrates
narcotics
beta blockers
- decrease myocardial tissue oxygen
diuretics
- if pulmonary edema occurs
sedatives
antiarrhythmias
stool softeners
- straining can cause vagal stimulation, producing bradycardia and dysrhythmias
“OH BATMAN”
myocardial infarction management
vitals
daily weights
intake and output
tPA can be given to dissolve the thrombus in coronary artery and reperfuse the myocardium
induce hypothermia in cardia arrest survivior ASAP after return of spontaneous circulation
- target temp: 32-34 Celsius (89.6 - 93.2 farenheit)
monitor for abnormal heart sounds, esp S3 and gallop
apply antiembolism stockings and tretments
check for cough, tachypnea, crackles
ECH should be continuous
reinforce GRADUAL reconsumption of sexual activity
collarbote with dietitician
risk factors for heart failure
heart infection
- endocarditis
- myocarditis
infiltrative disorders
- amyloidosis
tumors
sarcoidosis
collagen-vascular disease
- systemic lupus erythematosus
dysrhythmias that reduce cardiac filling time
disorder that increase cardiac workload
- anemia
- hyperthyroidism
right sided heart failure manifestations
weight gain
jugular vein distention
bilateral dependent peripheral edema
liver enlargement
- hepatomegaly with abdominal pain
- anorexia
- nausea
ascites
left sided heart failure manifestations
fatigue
cough - often initally dry
mild weight gain
shortness of breath
orthopnea
paroxysmal nocturnal dyspnea tachypnea crackles third heart sound cardiac cachexia mucle weakness
frothy sputum - blood tinged
restlessness irritability hostility agitation anxiety
prominent crackles throughout lung fields
diaphoresis
cyanosis
