Cardiovascular Nursing part 2 Flashcards
Conduction system, Valvular diseases, Pericarditis, Endocarditis, Cardiomyopathy, Hypertension, SNS vs PNS, ECG
Atrioventricular valves close
S1 (LUB)
Semilunar valves close
S2 (DUB)
Rapid ventricular filling / ventricular gallop
S3 (LUB-DUB-DUB)
atrial systole / atrial gallop
S4 (LUB-LUB-DUB)
4th ICS Left Parasternal
Tricuspid Valve
2nd ICS Right Parasternal
Aortic Valve
5th ICS Left Midclavicular line
- point of maximal impulse (PMI)
Mitral (Apex) Valve
2nd ICS Left Parasternal
Pulmonic Valve
inability of valves to close completely
Valvular Insufficiency / Valvular Regurgitation
ballooning of valve, with systolic click
Mitral Valve Prolapse
inability of the valves to open completely; asymptomatic (bc heart can compensate)
Valvular Stenosis
complication of Mitral Valve Prolapse
- mitral regurgitation
- dysrhythmia
visceral part of heart
epicardium
layers of heart
endocardium
myocardium
epicardium
pericardium
inflammation of pericardium
pericarditis
Most COMMON cause of Myocarditis
VIRAL disease
Most important symptom of Pericarditis
(+) Chest pain
- worsens with deep inspiration, lying down or turning
- relieved by sitting and leaning forward (orthopneic)
leathery, scratching, creaky sound heard best at the END OF EXPIRATION
Friction Rub
most common sign of pericarditis
Friction Rub
where to auscultate friction rub in pericarditis?
4th ICS Left Parasternal (Tricuspid Valve)
BQ concept:
Which is more definitive MRI or biopsy?
- Biopsy bc more accurate if one can see
heart is compressed due to swelling
Constrictive Pericarditis
2 Complications of Pericarditis
Pericardial effusion
Cardiac Tamponade
Cardiac Tamponade:
Beck’s Triad
-hypotension
-distended neck veins / JVD
-muffled (distant) heart sounds
(+) Beck Triad management
Call the doctor! to do pericardiocentesis
aspiration of fluid from the pericardium, performed by the physician and assisted by a nurse
Pericardiocentesis
procedure that allows the doctor for proper placement of needle before pericardiocentesis to avoid puncturing of heart
Chest X-Ray
nursing action in pericardiocentesis
connect patient to ECG and it must be normal
abnormal: possible punctured
inflammation of the endocardium
endocarditis
etiology of Infective Endocarditis
Bacteria (GABHS)
Signs of Systemic Inflammation
-intermittent fever
-night sweats
-fatigue
-weakness
- malaise
S/sx of Embolization:
-painful nodules on fingers, pads, and toes
-Osler’s nodes
S/sx of Embolization:
-white centered retina hemorrhages
-Roth’s spots
S/sx of Embolization
-bleeding under nails
- Splinter Hemorrhages
S/sx of Embolization:
-painless macules on palms and nodes
- Janeway Lesions
Endocarditis:
FROM JANE
Fever
Roth Spots
Osler nodes
Murmur
Janeway Lesions
Anemia
Nailbed hemorrhage
Emboli
Prevention/ Prophylactic Medication for Endocarditis
Antibiotic (Penicillin)
if (+) allergy: Erythromycin / Amoxicillin/ Azithromycin
disease of heart muscle associated with cardiac dysfunction
Cardiomyopathy
most common significant dilation (nabanat) without hypertrophy and systolic dysfunction
Dilated Cardiomyopathy
Diffused Necrosis (Dilated Cardiomyopathy)
- alcohol
- viral infection
- Pregnancy
autosomal dominant disorder, interventricular septum thickens ; may have sudden death
Parent (+): 50% child to acquire
Hypertrophic Cardiomyopathy
least common cardiomyopathy, caused by rigid ventricular walls; may lead to sudden death
Restrictive Cardiomyopathy
infiltration of fibrous and adipose tissue from Right ventricle until entire heart is affected
Arrythmogenic Right Ventricular Cardiomyopathy
what to assess for cardiomyopathy?
Family History!
diagnostic test for cardiomyopathy
2DEcho
only surgery and cure for cardiomyopathy
Heart Transplant
-Ventricular Assistive Device (VAD)
assist heart fx, if no HT yet
Average BP
110/70
<120 / <80
Normal BP
AHA: 120-129 / <80
Elevated
<120-139 / 80-89
Prehypertension
140-159 / 90-99
AHA: 130-139 / 80-89
Stage 1 HPN
≥ 160 / ≥ 100
AHA: >140 / >90
Stage 2 HPN
Hypertension is a disease
- idiopathic
Primary Hypertension
Hypertension is a SIGN of a disease (e.g. DM, Renal Dse, pheochromocytoma)
Secondary Hypertension
most important risk factor of HPN
Familial History
silent killer disease (asymptomatic)
Hypertension
Diet for HPN
low salt low fat, low sugar
Nursing Actual/Risk Diagnosis for HPN
Acute Pain related to -headache
Disturbed sensory/visual perception - blurred vision
Risk for fall/injury -dizziness
Risk for aspiration - epistaxis
Risk for ineffective airway clearance
(Asymptomatic)
Knowledge Deficit
Ineffective Health Maintenance
Non-compliance
Exercise for HPN
3x a week 30 mins per day
tumor in the adrenal gland (medulla)
↑epinephrine/adrenaline
↑norepinephrine/noradrenaline
leading to ↑SNS
Pheochromocytoma
↑HR
Bronchodilation
Pupil dilation
Vasoconstriction
↓Digestion
Urinary retention
Sympathetic Nervous System
↓HR
Bronchoconstriction
Pupil constriction
Vasodilation
↑Digestion
Bladder Emptying
Parasympathetic Nervous System
Nervous System
(+) acetylcholine
(+) epinephrine
Sympathetic Nervous System
Nervous System
(+) acetylcholine
Parasympathetic Nervous System
No Pulse
Irregular, No P Wave, No QRS
Ventricular Fibrillation
No Pulse
Regular, No P Wave, No QRS
Ventricular Tachycardia
Irregular, No P Wave, Wide QRS
Torsade de Pointes
(Type of Ventricular Tachycardia)
-No Pulse
&
Premature Ventricular Contraction
-w/ pulse
Rate: Very fast (150-250bpm)
Regular, P Wave Hidden, Normal QRS
Supraventricular Tachycardia
Regular or Irregular, P Wave, ST Elevated
STEMI (ST Elevation Myocardial Infarction)
Erratic waves, QRS normally narrow but not always
Irregular, No P Wave, Normal QRS
Atrial Fibrillation
“Sawtooth” Pattern
Regular or Irregular, No P Wave, Normal QRS
Atrial Flutter
Rate: Fast (>100bpm)
Regular, P Wave, Normal QRS
Sinus Tachycardia
Rate: Slow (<60bpm)
Regular, P Wave, Normal QRS
Sinus Bradycardia
Rate: Normal (60-100bpm)
Regular, P Wave, Normal QRS
Normal Sinus Rhythm
Shockable Rhythms
-Ventricular Fibrillation
-Ventricular Tachycardia
-Torsade de Pointes (Type of VTach)
Atrial Depolarization
P wave
Ventricular Depolarization
QRS Complex:
0.04 - 0.1 second
-time it takes an impulse to travel from the atria through AV node, BoH, and to the Purkinje fibers
-AV Depolarization
PR Interval:
0.12 - 0.20 second
early ventricular repolarization
ST Segment
ventricular repolarization and ventricular diastole
T Wave
ventricular refractory time or the total time required for ventricular depolarization and repolarization
QT interval:
0.32 - 0.40 second
each small square in ECG strip represents
0.04 second
each large square in ECG strip represents
0.20 second