Cardiovascular Part 2 Flashcards
Electrical Therapies
- Defibrillation
- Cardioversion
- Pacemakers
- Permanent
- Temporary
- Implantable cardioverter defibrillator (ICD)
Defib
UNSYNCHRONIZED (untimed) delivery of high voltage shock
Tx: Lethal dysrhythmias like VF and pulseless VT -
- If no pulse or if they have V-tach it can very quickly deteriorate into V-Fib so SHOCK THEM
- If HAVE pulse and yet are V-tach, we’ll give medications instead - LOOK on discussion board
Nursing: Never defibrillate a conscious pt with a pulse
Synchronized cardioversion
SYNCHRONIZED (Timed) with QRS, no shock on T wave
Tx: tachyarrhythmias like afib
Nursing Considerations: Consent, NPO prior, r/o thrombus, pt take anticoagulants, O2, sedation & pain control provided, assess VS, LOC during & post
Be sure no one touching bed during electrical discharge
What is Afib?
The atria aren’t contracting at regular rate, they’re just sitting there like bowl of jello and then sometimes pump out a beat, so only occasionally the electrical impulse gets through and as the atria are just sitting there, the blood is in there swirling around and because blood is sticky, they’ll cause a blood clot; and so when atria start to kick out a beat, the clot will go through and can go to pulmonary (for pulmonary embolism) or to brain (stroke)
Pacemaker
**Temporary
-Tx: after open heart surgery
-Nursing:
Wear gloves when handling leads/connecting cables
Don’t touch pacemaker components on first entering room
Keep dressings dry
**Permanent
-Tx: symptomatic bradycardia, 3rd degree blocks, sick sinus syndrome
-Nursing:
Device programmed when inserted/checked by HCP
Educate patient
Insertion site initial care
Report s/s infection
Immobilization of arm until cleared by cardiologist
Avoid electromagnetic fields (notify airport security)
Avoid contact sports
Wear medic alert bracelets
Patient education with pacemakers
- pts can’t push or pull with arms or circling arms when first have pacemaker (prob for about 2-6 weeks, but depends on number of leads and age of patients)— need scar tissue to build up around pacemaker and leads before too much movement. might put pt in sling so they won’t move…also education family
- have to come into clinic within a week to look at incision site
- we also need to have them come in so we can monitor if it’s sensing and capturing
Implantable cardioverter defibrillator (ICD)
ICD - is a pacemaker that can detect a lethal arrhythmia and then shock the patient to reset it!
- May be combined with pacemaker
- Tx: lethal dysrhythmias
- Nursing:
Same as pacemaker
Do not place defib pads on/near generator
Address concerns r/t shock delivery
Blood Pressure Continuum
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Clinical Manifestations of Hypertension
HA Vision Changes Numbness/tingling in extremities - we ask about this cause we want to know if they’re having stroke d/t HTN SOA Fatigue Epistaxis - nosebleed
Nursing Management of Patients with Hypertension
Life Style Alteration Approximate BP Change
Weight Reduction Reduces by 5-20 mmHg
Diet Change Reduces by 8-14 mmHg
Sodium Reduction Reduces by 2-8 mmHg
Regular Exercise Reduces by 4-9 mmHg
Decrease ETOH Reduces 2-4 mmHg
Sugar Reduction Sugar intake may increase BP
Smoking cessation Linked to BP increase in many.
Medication (dose, SE, intake, resources, cautions) Depends on med
Hypertensive Crises
*Acute and life threatening
*Signs and Symptoms BP usually > ~ 180/120 HA Confusion/change in neuro status Blurred vision Tachycardia and tachypnea Dyspnea
*Interventions Maintain patent airway Administer antihypertensive medications IV Assess for hypotension or fluid volume overload Slowly reduce BP (over hours/days) Monitor VS and I&O’s Bed rest, HOB ~ 45 degrees Must have emergency equipment available
Relationship of Atherosclerosis to Ischemia, Angina, and Myocardial Infarction
- Ischemia
- Angina
- Stable Angina
- Unstable Angina
- Angina
- Myocardial Infarction
NOTES:
Unstable - don’t know cause or trigger and doesn’t get better with rest or nitro;
if there’s ST it needs to be at least two boxes elevated (looks like Fire Hat on strip) and it means an MI; if
there’s ST depression, two millimeters (boxes) that means there’s ischemia.
will look at labs and cardiac enzymes, if elevated and also elevated ST then STEMI
But Non-STEMI, elevated labs, but not see ST elevation
Clinical Manifestations of Angina
*Chest Pain/discomfort and left arm pain
- for pain:
ASSESS:, Need to RATE pain; what makes it better or worse?; have you taken any meds for this yet?
*Palpitations
*Fatigue
*ECG and BP changes
*cardiac enzymes
*Limb numbness/tingling
*SOA/tachypnea
*Diaphoresis
*Anxiety/restlessness
*Dizziness/Lightheadedness
*N/V
Nursing Management
**Treat as emergency until determined otherwise
this angina is basically a O2 supply/demand problem
SOOO….Correct O2 supply/demand
**Control Comorbidities /Prevent Disease Progression
Hypertension
Diabetes
Hyperlipidemia
**Life Style modifications/Reduce Risks
**Patient Education Disease process Risk Factor Modification/Prevention Medications Nitroglycerin-Pg 403
How to use Nitroglycerin oral spray
- Remove the plastic cap.
- Do not shake the container.
- If this is a new bottle or container, prime the pump before use by releasing a test spray. This must be done 5 or 10 times into the air away from your face and other people.
- If this is an old bottle and you have not used it for more than 6 weeks, you must prime it again with 1 or 2 test sprays. If it is not been used within 3 months, prime it up to 5 sprays.
- Hold the container upright with your forefinger on top of the grooved button. Open your mouth and bring the container as close to it as possible.
- Press the button firmly with the forefinger to release the spray 1 or 2 times onto or under the tongue. Do not inhale or breathe in the spray.
- Release the button and close your mouth, but do not swallow right away. Do not spit out the spray or rinse your mouth for at least 5 to 10 minutes.
- If you need a third spray, you must wait 5 minutes after the second spray. Use exactly the same steps you used for the first spray. No more than 3 sprays should be given within 15 minutes.
- Replace the cover after using the medicine.
- Always place the spray bottle in an upright position if not in use. Also, check the fluid level of Nitromist® container regularly. If the fluid reaches the top or middle of the hole on the side of container, this is an indicator that you must get a refill.
- Do not use the spray near heat, an open flame, or while smoking.
Nursing Management of Angina
**Treat as emergency until determined otherwise
this angina is basically a O2 supply/demand problem
SOOO….Correct O2 supply/demand
**Control Comorbidities /Prevent Disease Progression
Hypertension
Diabetes
Hyperlipidemia
**Life Style modifications/Reduce Risks
**Patient Education Disease process Risk Factor Modification/Prevention Medications Nitroglycerin-Pg 403
Coronary Artery Bypass Graft (CABG)
There’s a less invasive procedure but we talked about when they cut through sternum
CABG is surgery to use veins from body to bypass occluded after in heart.
Most common vein for CABG is the saphenous vein in leg and because it’s a vein they have to strip the valves out of the vein to make it an artery; sometimes they also use the internal mammary artery (LIMA)
Nursing Management post-CABG
- *Hemodynamic Stability
- *Adequate gas exchange
- *Fluid-volume balance
- *Pain management
- *Sternal precautions/Wound care
- *Progressive activity
**Patient Education
Smoking Cessation Counseling (TJC Core Measure)
Meds (SAAB-TJC Core Measures)
Risk Factors & life style modifications
When to call physician and/or 911
Psychological factors
NOTE on Meds: according to TJC core measures, pts have to be on 4 meds no matter what:
- cholesterol lowering medication
- aspirin,
- ACE inhibitor or ARB
- beta blocker when discharged
Heart Failure
DEFINITION: Inability of heart to pump effectively; with HF, valves in veins get stretched and CAN’T meet the circulation demands of the body; additionally, d/t stretched valves, the blood can go through even if it’s not supposed to and you can get regurgitations
TJC Core Measure r/t high readmission:
- Discharge Instruction/Education material documented
- Evaluation of ejection fraction (EF) on chart
- Document Medications
Risk Factors for HF
Genetics Lifestyle Factors Psychological stress Low socioeconomic status Complications from disease processes
Right Side HF
Peripheral Congestion
- JVD
- Dependent Edema
- Ascites
- Hepatomegaly
- Splenomegaly
- Anorexia/Nausea
- Weight Gain
Patient Education for HF
- Education
- Life Style Changes: Diet - Na+; Fluid Restriction - 2L
- Self-management strategies: Daily weight - to see if meds are working; Activity (planning/rest periods)
- Signs and Symptom Recognition
- When to contact physician or call 911
- Medications
Medical Management of HF
**Diagnostic testing
**Lifestyle Modification - same as CAD, HTN and MI
**Pharmacologic Treatment (MEDS)
**Non-Surgical Treatment
Ultrafiltration - this is big dosw of diuretics
**Surgical Treatment Cardiac resynchronization Pacemaker/defibrillators Ventricular access device Transplant
NOTE on Meds and follow up:
Meds: Spirinolactone, and meds to help pumping ability, such as a beta blocker, or Digoxin (will need to track this med with labs), Diuretics and we’ll ask them to take daily weights to know if diuretics are effective - do at same time, with same scale and same kinds of clothes..so best 1st thing in the morning; we want to know if there’s a gain of 5-7 lbs in one week
Nursing Management of HF
Acute phase/exacerbations
- High Fowler’s position
- Oxygen administration
- Rapid assessment: VS, lung sounds, LOC, perfusion, wt, etc.
- IV; prepare to administer medications
- I&Os
- Prepare for administration of medications: Diuretics (furosemide), ACE/ARB, digitalis (Digoxin), etc.)
- Labs: ABGs, electrolytes, BNP
- Psychological support
