Cardiovascular Nursing Care Flashcards
This is the muscle length prior to contractility. It is dependent of ventricular filling for end diastolic volume and this value is related to R atrial pressure. The most important determining factor is venous return.
Preload
What is afterload?
It is the tension or the arterial pressure against which the ventricle must contract. If atrial pressure increases, this also increases.
This is the intrinsic ability of cardiac muscle to develop force for a given muscle length. It is also known as inotropism.
Contractility
CO = SV x HR
Cardiac output = stroke volume x heart rate
Each heartbeat is the result of an electrical stimulus. The impulse which originates in the SA nose in the R atrium is conducted through a network of fibers w/in the heart and finally stimulates the myocardium to contract
Conduction
This causes a discharge of electrical forces from within the membrane
Depolarization
After contraction, the muscle cells recover and restore electrical charges within
Repolarization
What is the cardiac cycle?
Combined periods of polarization and repolarization
What are age related differences?
Decreased elasticity, thickening and rigidity of valves. Increased connectivity tissue in the SA and AV nodes and bundle branches
What are gender related differences?
Women - arteries and heart are smaller, HR, SV and ejection fraction higher in women. Hormone protection pre menopause + clotting
What are racial/ethnic differences?
Essential HTN incidence, DM, access to health care and treatments, mortality and morbidity
What are some pathogenic risk factors?
Hyperlipidemia + hypolipoproteinemia, HTN, glucose intolerance, hypercoagulation states
Gender, age, family hx of CAD and ethnicity are what kind of risk factors?
Non modifiable
What are some assessment techniques you would use for a pt with CVD?
Hx, demographic data, family hx and genetic risk, personal hx, diet hx and socioeconomic status
Chest pain can also result from noncardiac problems. Name four
Pleurisy, pulmonary embolus, hiatal hernia and anxiety
Women often do not experience pain in the chest and instead feel either or both of these
Discomfort or indigestion
Difficult or labored breathing experienced as uncomfortable breathing or SOB
Dyspnea
What is orthopnea?
Dyspnea when lying flat
When does paroxysmal nocturnal dyspnea occur?
After lying down for several hours
This enzyme is specific to cells of the brain, myocardium and skeletal muscle. The appearance of this enzyme in the blood indicates tissue necrosis or injury
Creatinine kinase
Elevations indicate possible brain myocardial and skeletal muscle necrosis or injury
Creatinine kinase
What does CK-MM measure? (100% of total CK)
Elevations that occur with muscle injury
This measures elevations that occur with myocardial injury or after percutaneous transluminal angioplasty and intracoronary streptokinase infusion
CK-MB (CK2) (0% of total CK)
What does CK-BB (CK1) measure?
Elevations that occur with brain tissue injury
What does C reactive protein measure? (<1.0 mg/dl)
Elevations may indicate tissue infarction or damage
Client preparation for cardiac catheterization includes?
Assessment of the patient’s physical and psychosocial readiness and knowledge level, purpose, length, who will be present during the procedure and appearance of the cath lab.
These complications may occur during catheterization.
MI, stroke, thromboembolism, arterial bleeding, lethal dysrhythmias and death
Follow up care of a cardiac catheterization includes
restricted bedrest, insertion site extremity is kept straight, monitor V.S and assess for complications
What is hemodynamic monitoring?
It is an invasive system used in critical care areas to provide quantitative information about vascular capacity, blood volume, pump effectiveness, and tissue perfusion
This type of monitoring directly measures pressures in the heart and great vessels
Hemodynamic monitoring
What is a pulmonary artery catheter?
It is a multi-lumen catheter with the capacity to measure right atrial and indirect left atrial pressures or PAWP
What does systemic intra-arterial monitoring measure?
It is a direct measurement of arterial BP
This type of cardiography measures the total resistance to the flow of electricity in the heart. It provides measures of thoracic fluid, left ventricular function, preload, afterload, and contractility of the heart.
Impedence cardiography
Physical assessment of a pt with cardiovascular problems include?
General appearance, integumentary system, skin color, skin temperature, extremities, blood pressure, venous and arterial pulses
Assessment of the precordium (area over the heart) involves:
inspection, palpation, percussion, auscultation (normal heart sounds, paradoxical splitting, gallops (S3 always CHF) and murmurs, pericardial friction rub
Upon PE, reduced pulse pressures, cardiac enlargement, murmurs and gallops will indicate:
effectiveness of the heart as a pump
Upon PE, JVD, congestion, peripheral edema and postural HTN will indicate:
filling volume and pressures
Upon PE, cognition, HR, pulse pressure, color and texture of skin, uring output will indicate:
Cardiac output
Upon PE, HR and hemodynamic changes will indicate:
Compensatory mechanisms
Drug management for cardiovascular care include
drug management, surgery treatment, preventative/health promotion
Control BP and volume, contractility, SV, HR, vasodilation, anti-lipids, anti-PLTs and anti-coagulants are all
drug management
What is a PTCA?
Percutaneous transluminal coronary angioplasty is an invasive but nonsurgical technique that reduces the frequency and severity of discomfort for clients with angina and to bridge clients to coronary bypass graft surgery
In an emergent situation, what would you consider for a cardiovascular pt?
ABCD - airway, breathing, circulation and differential diagnosis
It is believed that the artherosclerotic plaque in the coronary artery ruptures and results in PLT aggregation, thrombus formation and vasoconstriction. This is because of
acute coronary syndrome
The 1st assessment for a pt with ACS is one in how many minutes? What what you assess for?
<10 min, s/s, risk factors, hx, screening for fibinolytics, 12 lead
What does MONA stand for?
Morphine, oxygen, nitrates (NTG 1 q 5 minutes x 3) and aspirin
You would observe these assessments of a pt with angina:
chest pain with exertion or stress relieved by rest and NTG, dyspnea, weakness, numbness, N/V, diaphoresis, pallor and dizziness
NTG (Isordil), beta blockers, Ca channel blockers, anti-PLT (ASA, Plavix) and anti-coagulants (heparin) are all medications for treating what
Angina
Name some nursing dx for angina
Pain, ineffective myocardial tissue perfusion, activity intolerance, anxiety r/t fear of death, role loss, decreased cardiac output, ineffective management of therapeutic regimen
Nursing care for angina includes:
obtain V.S, pain assessment and relief, assess effectiveness and time span of NTG, remain calm, stay w/pt, oxygen (medical) but usual 2L/NP
Treatment goals for angina include:
keep blockage from increasing (ASA), relieve pain/anxiety (morphine), prevent/treat arrythmias (lidocaine, vasodilators, beta blockers, limit size of infarction (decrease oxygen demand), recognize and treat cardiac failure
What are the clinical manifestations of angina?
Chest pain and autonomic responses, weakness and myocardial dysfunction, dysrhythmias and muscle enzymes
Nursing care for a pt with angina are:
assessment of s/s lasting after NTG w/out relief, notify MD, prepare for code, and txfer pt to critical care
Some issues for pt’s post-op care are:
cardiac rhythm, blood loss (chest tubes and drains), wound care, fluid balance, medications (titrating vasoactive and inotropic drugs)
Notify MD of the following hemodynamic parameters:
-cardiac index 90mmHg, SvO2 <60%
Notify MD of the following:
cardiac dysrhythmias, changes in sensorium, temperature 35 or > 38.5, urine output 100mL/hr x 2hrs
Notify MD of lab values when:
Hct 50mmHg, ph 7.5, Ionized Ca <4.5 mEq/L
Notify MD STAT of signs of cardiac tamponade AEB
cardiac index 130bpm, muffled/distant heart tones, pulsus paradoxus>15mm Hg during inspiration, elevated PAD >20mmHg, CVP >20mmHg, narrowing pulse pressure-systolic blood pressure>70mmHg, distended neck veins, SvO2<60% or changed by 10%
What are the hallmarks of cardiac tamponade?
Sudden cessation of previously heavy mediastinal drainage, JVD but clear lung sounds, pulsus pardoxus (BP > 10mmHg higher on expiration than on inspiration), an equalizing of PAWP and R atrial pressure and cardiovascular collapse
This is the general term for the inadequacy of the heart to pump blood throughout the body; causes insufficient perfusion of body tissue with vital nutrients and oxygen
Heart failure
Assessment of L sided failure include:
decreased CO, oliguria, altered mental status-confusion, tachycardia, palpitations, pulmonary - dyspnea, PND, tachypnea, crackles
Assessment of CHF include:
same a L sided failure but with hepatomegaly, JVD, edema
Fluid excess, pain, altered comfort, gas exchange, breathing pattern, CO, tissue perfusion, injury r/t medications, diagnostic tests are all
nursing diagnoses for heart failure
Interventions for gas exchange include:
Ventilation assistance, hemodynamic regulation, energy management, diet therapy, drug therapy
Optimization of CO and drug therapy (ACE, ACE inhibitors, diuretics, human B type natriuretic peptides, nitrates, inotropics, beta adrenergic blockers are all interventions for
Decreased CO
Interventions for this include a reduction of afterload and preload, improve cardiac muscle contractility, administer meds, monitor for therapeutic and adverse effects, and teach client and family drug therapy
Hemodynamic regulation
Some common nursing diagnoses for hemodynamic regulation include:
decreased CO r/t altered stroke volume, impaired gas exchange r/t ventilation perfusion imbalance, activity intolerance r/t inability of the heart to meet metabolic demands during activity, acute pain r/t physiologic injury agent
What are some drugs that reduce preload?
Diet therapy and drug therapy (diuretics and venous vasodilators)
ACE inhibitors and human B type natiuretic peptides reduce
Afterload
In drugs that treat both preload and afterload, what would observe for?
K+ levels, orthostatic hypotension, PE and renal dysfunction
Interventions for activity intolerance include:
Ventilation assistance, hemodynamic regulation, energy management and interdisciplinary interventions which regulate energy to prevent fatigue and optimize function
Interventions for PE include:
asses for early signs, such as crackles in the lung bases, dyspnea at rest, disorientation and confusion, rapid acting diuretics (lasix or bumex), oxygen and strict I&Os
Thrombosis, emboli and atheroplagues are occlusive disorders of
PVD: Arterial
Manifestations of PVD include:
intermittent claudication, resting pain, paresthesias, ulceration, 6 P’s (pulseless, pain, pallor, paresthesia, paralysis, and poikilothermia (coolness)
