Cardiovascular Disorders Flashcards
1
Q
Nursing Diagnoses Related to Cardivascular Disorders
A
Activity Intolerance Anxiety Decreased cardiac output Ineffective coronary tissue perfusion Fluid volume excess Impaired gas exchange Knowledge, deficient Pain
2
Q
Decreased Cardiac Output is Related to…
A
Altered heart rate or rhythm
Altered stroke volume
Altered preload (decreased venous return)
Altered afterload (increased systemic venous return, increased BP)
Altered contractility
3
Q
Risk Factors for Ineffective Tissue Perfusion
A
Hypertension, hyperlipidemia, coronary artery spasm, diabetes mellitus, cardiac surgery
4
Q
Autonomic Nervous System
A
Controls the heart rate
5
Q
Sympathetic/Parasympathetic Nervous System
A
Stimulates norepinephrine to increase heart rate
6
Q
Baroreceptors
A
Pressure receptors located in the aortic arch, carotid sinuses
Have special nerve endings to detect changes in arterial blood pressure
7
Q
Stretch Receptors
A
Found in the vena cava, respond to pressure changes
8
Q
Antidiuretic Hormone (Vasopressin)
A
Influences blood pressure by regulating vascular volume
Keeps blood pressure high by retaining water
9
Q
Renin
A
Vasoconstrictor to increase blood pressure
10
Q
Aldosterone
A
Promotes water and sodium retention to increase blood pressure
11
Q
S1
A
First heart sound, closing of the AV valves
12
Q
S2
A
Second heart sound, closing of the semilunar valves
13
Q
S3
A
Normal if under 30 years old, caused by decreased ventricular compliance
14
Q
S4
A
Ventricular resistance to filling, caused by injury
15
Q
Cardiac Catheterization and Angiography
A
Helps to visualize the heart’s chambers, valves, great vessels, and coronary arteries
Measures pressures inside of the heart
Uses contrast iodine
16
Q
Nursing Interventions for Pre-Op Cardiac Catheterization and Angiography
A
Education, teach about “warm” feeling of iodine, screen for iodine allergy, keep NPO, get consent, observe recent vital signs, know the coags, review the lab work (CBC, BMP, potassium level), mark pedal pulses
17
Q
Nursing Interventions for Post-Op Cardiac Catheterization and Angiography
A
Get vital signs every 15 minutes, assess circulation-sensation-movement of extremity accessed, assess pressure dressing, position on their back, encourage fluids
18
Q
Complications of Cardiac Catheterization and Angiography
A
Diabetic patients taking Glucophage have increased risk of kidney damage with the contrast dye
Hemorrhage
Reocclusion
19
Q
Echocardiography
A
Ultrasound directed at the heart
Helps to get information about the CO, EF, and valves
Cardiac Output = HR x SV (EF is the same)
20
Q
Normal Cardiac Output for Left Ventricle
A
60-65%
21
Q
Cardiac Output with Moderate Heart Failure
A
40-60%
22
Q
Cardiac Output for Moderate to Severe Heart Failure
A
20-40%
23
Q
Cardiac Output with Severe Heart Failure
A
< 20%
24
Q
Electrophysiology
A
Stimulation of the heart with equipment to cause lethal rhythms in order to locate accessory pathways and cauterize them
Electron Beam Computer Tomography is used for accurate location of calcium in the heart
25
Stress Tests
Monitoring cardiac function under stress (treadmill, exercise bike)
With or without echo or nuclear imaging (Thallium)
If unable to exercise --> give drugs to mimic exercise (Dipyridamole [Persantine], Adenosine [Adenocard])
26
Nursing Interventions for Stress Tests
Keep NPO, hold beta blockers (decrease heart rate), prepare patients for long tests
27
Electrocardiography
ECG/EKG
Typically 12 leads
Measures heart rhythms
Holter Monitor: wear for 48 hours, press button if you have chest pain or dizziness
28
P Wave
Depolarization of the atria
29
QRS Complex
Depolarization of the ventricles
30
T Wave
Repolarization of the ventricles
31
Cardiac Monitoring
Have patient notify if they experience chest pain, SOB, palpitations
Check surrounding skin, make sure there is a tight seal, change pads
Communicate with person watching telemetry monitor
Never remove the telemetry monitor just do the patient can shower
32
Red Blood Cell Values
Men: 4.5-6.2 million cells/microliter
Women: 4.0-5.5 million cells/microliter
Polycythemia: result of chronic hypoxemia, increased red blood cells
33
White Blood Cell Values
5-10 cells/mm3
Differential: neutrophils, bands, eosinophils, basophils, lymphocytes, monocytes
"Shift to the Left" = increased immature neutrophils
34
Platelet Values
150,000-400,000 cells/mm3
35
Hemoglobin/Hematocrit Values
Male: 14-18 g/dL and 42-52%
Female: 12-16 g/dL and 37-47%
36
Erythrocyte Sedimentation Rate
Inflammatory condition indicator
37
Sodium Values
135-145 mEq/L
38
Potassium Values
3.5-5.1 mEq/L
39
Calcium Values
8.6-10 mg/dL
40
Magnesium Values
1.6-2.6 mg/dL
41
Total Cholesterol Goal
Less than 200
42
HDL
Healthy, high density lipoprotein
43
LDL
Increased risk of cardiovascular disease
44
VLDL
Increased risk of cardiovascular disease
45
Hyperlipidemia
Increased concentration of any/all lipids in the blood
46
Cardiac Enzymes
Proteins from the cell that are released when there is cell death in the tissue
47
CK-MB (Creatine Kinase, Myocardial Muscle)
Increases with cell death
48
LDH (Lactic Dehydrogenase)
Increases with cell death
49
TROPONIN 1
Gold standard of cardiac markers
Normal level is 0.6ng/mL
Increases with cell death within 3 hours of heart damage
50
Myoglobin
Released after MI or skeletal muscle injury
51
B-Type Natriuretic Peptide
100 pg/mL
Increases with heart failure
52
Homocysteine
< 14 mmol/dL
Increases risk of cardiovascular disease
53
C-Reactive Protein
Indication of inflammation
54
Hypertension
Blood pressure above 149/90
55
Diabetes and Coronary Artery Disease
Accelerates heart disease, hyperglycemia causes increased aggregation, alters RBCs
56
Angina Pectoris
Chest pain
Diagnosed by history, cardiac tests
Anti-platelet aggregation therapy (low-dose aspirin, Plavix)
Vasodilators: Nitroglycerin
Beta-adrenergic blocking agents (decrease heartbeat and blood pressure)
Calcium channel blockers (vasodilate)
57
Coronary Artery Bypass Graft (CABG)
Treatment for angina pectoris, uses a saphenous vein graft and/or left internal mammary artery
58
Percutaneous Transluminal Coronary Angioplasty
Goes through an artery, uses a ballon, opens up the occluded area
Need consent because it is invasive and the balloon could pop, warranting an emergency CABG
59
Complications of CABG and PTCA
Vascular injury, bleeding, heart attack
60
Nursing Care for Angina
Promote comfort (decrease contributing factors, give morphine)
Promote tissue perfusion
Promote rest/relief of anxiety/feeling of well-being
Teach patient and family
61
Nursing Interventions for Angina
Stop all activities, place patient in Semi-Fowler's, administer oxygen
Give nitroglycerine every 5 minutes 3 times as needed for pain (if there is still pain after the third one, contact the physician)
Assess pain, blood pressure, and pulse before each drug
DO NOT give if they take medications for sexual dysfunction
62
Valvular Heart Diseases
Prolapse, Regurgitation, Stenosis
Caused by congenital abnormalities or rheumatic fever
63
Signs and Symptoms of Valvular Heart Disease
Fatigue, angina, oliguria, pale skin, weight gain, edema, dyspnea, abnormal breath and heart sounds
Symptoms of decreased cardiac output
64
Diagnosing Valvular Heart Diseases
Echocardiogram and/or heart catheterization are best
Chest X-Ray, ECG
65
Pharmacological Management of Valvular Heart Diseases
Diuretics (decrease extra fluid; need to restrict sodium)
Digoxin (slows and strengthens the heart)
Antidysrhythmics (helps with conduction problems)
66
Commissurotomy
Surgically splitting fused valves
67
Annuloplasty
Tightening leaflets
68
Cardiomyopathy
Group of heart muscle diseases
Primary (genetic cause) or secondary (infective, metabolic, nutritional, alcohol, peripartum, drugs, radiation, SLE, rheumatoid arthritis)
69
Effects of Primary Cardiomyopathy
Decreased cardiac output
Sympathetic nervous system is stimulated
Renin-Angiotensin-Aldosterone response (systemic vascular resistance increases)
Increased sodium and fluid retention
Increased workload on heart and heart failure
70
Types of Cardiomyopathy
Dilated, Restrictive, Hypertrophic
71
Signs and Symptoms of Cardiomyopathy
Angina, syncope, fatigue, dyspnea on exertion, severe exercise intolerance
Signs and symptoms of left- and right-sided heart failure
72
Pharmacological/Medical Management of Cardiomyopathy
Diuretics (Lasix, furosemide --> decreased K+)
ACE Inhibitors (vasodilate)
Beta-Adrenergic Blocking Agents (slows everything down)
Treat the underlying cause
Internal defibrillators and/or cardiac transplants may be necessary
73
Rheumatic Endocarditis
Rheumatic fever occurs after a streptococcal infection (beta-hemolytic streptococci)
Causes scar tissue in the heart and develops into heart disease
74
Pharmacological/Medical Management of Rheumatic Endocarditis
NSAIDs
Treat infections rapidly and completely
Bed rest, application of heat to joints, well-balanced diets, encourage fluids
Commissurotomy or valve replacement
75
Endocarditis
Can be caused by bacteria, virus, or fungus
"Flicking of clots"
Seen frequently in IV drug users
76
Signs and Symptoms of Endocarditis
Influenza-like symptoms, petechiae, anemia, splinter hemorrhages, weight loss, heart murmur
77
Medical Management of Endocarditis
Bed rest, IV antibiotics for 1-2 months, prophylactic antibiotics, analgesics, antipyretics
Surgical repair/replacement of diseased valves
78
Pathophysiology of Myocarditis
Rheumatic heart disease
Viral, fungal, or bacterial infection
Endocarditis
Pericarditis
Tell patients to complete their course of antibiotics
79
Medical Management of Myocarditis
Bed rest, oxygen, antibiotics, anti-inflammatory agents
Monitor for cardiac enlargement, gallop, tachycardia
80
Pathophysiology of Pericarditis
Inflammation of the pericardium resulting in thickening and constriction
Caused by infections, Lupus, rheumatoid arthritis, immune reaction, MI, pneumonia, radiation, renal failure
81
Signs and Symptoms of Pericarditis
Debilitating chest pain that increases with movement, dyspnea, fever, chills, leukocytosis, signs and symptoms of heart failure
82
Medical Management of Pericarditis
Analgesics, salicylates (decrease inflammation), antibiotics, anti-inflammatory agents, corticosteroids, oxygen, IV fluids
83
Cardiac Tamponade
Heart unable to pump efficiently due to pressure from fluid buildup with pericarditis
Treatment includes a pericardial window, pericardial tap/pericardiocentesis
84
Causes of Heart Failure
Inflow of blood greatly reduced (trauma, hemorrhage, venous insufficiency, dehydration)
Outflow from heart obstructed (valves)
Damaged heart muscle (MI, pericarditis)
Metabolic demands increased (pregnancy, hyperthyroidism)
Arteriosclerosis
Neurohormonal conditions (brain trauma, tumors)
85
Left Ventricular Heart Failure
Most common, blood backs up into the lungs
Pulmonary congestion that leads to paroxysmal nocturnal dyspnea, orthopnea, cough, frothy pink sputum, pulmonary crackles, wheezing
X-Ray shows pleural effusion, pulmonary vascular congestion
86
Heart Failure Generalized Symptoms
Fatigue, shortness of breath, tachycardia
Angina, anxiety, restlessness, insomnia
Oliguria, decreased GI motility
Pale, cool, skin
Weight gain due to fluid buildup
87
Right Ventricular Failure
Distended jugular veins
Anorexia, nausea, and abdominal distention
Liver enlargement, ascites
Edema in the feet, ankles, sacrum that may progress up the legs into the thighs, external genitalia, and lower trunk
88
Diagnosis of Heart Failure
Chest X-Ray shows pulmonary effusion, cardiomegaly, pulmonary vascular congestion
ECG shows rhythm disturbances
Echo is gold standard, shows ejection fraction, stroke volume, valve problems, pericardial fluid
Heart Catheter shows ventricular function, checks occlusion of arteries
Stress testing checks activity tolerance
BNP > 100 pg/mL indicates heart failure
89
Pharmacological Management of Heart Failure
Digoxin (increases force of contraction, decreases heart rate): count apical HR for a full minute
Vasodilators (nitroglycerine, isosorbide)
ACE Inhibitors (decrease blood pressure): Vasotec, Enalopril, Capoten, Captopril
Beta Blockers prevent cardiac remodeling (left ventricle dilates and hypertrophies which stresses walls of ventricles and causes mitral regurgitation
90
Nursing Interventions of Heart Failure
Vital signs, head to toe assessment
Medications and oxygen
Increase position and activity gradually
Monitor fluid retention; weigh daily
Low sodium diet
91
Pulmonary Edema
Caused by left ventricular failure, fluid overload
Characterized by restlessness, agitation, panic, disorientation, diaphoresis, pallor, tachycardia, frothy pink sputum
92
Medical Management of Pulmonary Edema
Morphine sulfate (decreases anxiety and respiratory effort), nitroglycerin, diuretics, inotropic agents (Digoxin), vasodilators
Position in a high Fowler's position with legs hanging down
Oxygen, Foley catheter, stay with patients until stable
93
Shock
Inadequate tissue perfusion caused by systemic vascular resistance
Signs include hypotension, tachycardia, tachypnea, change in mental status, decreased urinary output
94
Cardiac Arrest
Cessation of cardiac output and circulatory collapse
Caused by v tach, v fib, asystole
Signs and symptoms include loss of consciousness, apnea, no pulse and no blood pressure, pupil dilation, pallor and cyanosis
Initiate CPR
95
V Tach
Shockable rhythm, with or without pulse, McDonald's arches
