CARDIOVASCULAR SYSTEM Flashcards
What are the causes and management of ventricular tachycardia
Causes- Ventricular ecotopics. The rate would be above 100bpm, extremely rapid up to 180bpm.
Management- Depends on the haemodynamic status of the patient, DC conversion if they have a raised blood pressure, Antiarrythmic agents (Amiodarone), correction of electrolyte and acid-base balance. If there is no pulse then CPR.
What are the causes and management of Atrial Fibrillation
Causes- Irregular and rapid chaotic atrial rates of between 350-600 beats per minute
symptoms- palpitations, fatigue, chest pain, shortness of breath, weakness
management- DC (Electrical) cardioversion. Digoxin to slow the heart rate and ensure better cardiac output.
What are the causes and management of Ventricular asystole
Causes- Absence of ventricular activity
Management- cardiopulmonary resuscitation, pacing, drugs (atropine, adrenaline) from the emergency trolley.
What are the causes and management of Ventricular fibrillation
Causes- Complete Electrical and mechanical disorganisation of cardiac rhythm. The ECG shows irregular waves of varying shape, size and rhythm and therefore no cardiac output. The patient is pulseless.
Management- Defibrillation and CPR.
What are the causes and management of Atrial ectopic beats (premature atrial contractions)
Causes- Extra premature beats in the atria due to emotion exertion or stimulation stimulants sympathetic overactivity hypoxia stress smoking anxiety also associated with valvular disease atrial Chambers enlargement and coronary heart disease
Treatment- is usually not required, the interventions should be aimed at treating the underlying cause.
What are the causes and management of Atrial flutter
Causes- Regular rhythm but very fast atrial contractions of about 250-300 bpm. Common in rheumatic heart disease. other diseases that cause are CAD, hypertension, cardiomyopathy, mitral valve disease.
Treatment- Cardioversion
What are the causes and management of third degree AV block
characterised by complete dissociation of the impulse between the atria and the ventricles. this is due to ischemia, degenerative changes in the AV node or to digoxin toxicity
treatment- pacing, atropine to increase the rate.
What are the causes and management of sinus tachycardia
this is a heart rate that is faster than 100 bpm in an adult. it may be due to exertion, pyrexia, emotion or a host of other factors.
management- based on the treatment of the underlying cause, reduction in oxygen demands, bed rest reduces metabolic demands therefore oxygen therapy can be given.
What are the causes and management of sinus bradycardia
the heart rate rhythm is normal but slower less than 60 bpm. treatment is treating the underlying cause and observation of the patient.
what are the modifiable risk factors
- Heredity
- Gender
- Age.
what are the non modifiable risk factors
- Smoking
- Poor nutrition
- High blood
cholesterol - High blood
pressure - Obesity
- Physical inactivity
- Stress and
behaviour.
what is cyanosis
Cyanosis indicates poor tissue oxygenation. Central cyanosis can be seen best on the lips and tongue, whereas peripheral cyanosis of the limbs or digits may indicate peripheral vascular disease.
what is pallor
- Pallor is a decrease in skin colour indicative of reduced circulating haemoglobin. It can be best observed on the nail beds, lips, oral mucous membrane, soles of feet, and palms of hands.
what is clubbing of the fingernails
The aetiology (causes) of clubbing is poorly understood, but it is related to hypoxia and poor circulation. If present, clubbing may indicate valvular heart disease, congenital heart disease, or chronic pulmonary disease.
what is cardioversion
A procedure done to restore the heart’s normal rhythm by applying controlled electrical shock or by use of medication.
what are the risk factors for cardiovascular disease
- Sedentary lifestyle- A lifestyle in which there is minimal physical activity is undertaken. Exercise stimulates circulation and is important for weight control.
- Unhealthy diet, cholesterol and other fats- A diet that is high in fat, salt, carbohydrates and added sugar is unhealthy.
- Obesity and overweight
- Use of tobacco
- Hypertension
- Diabetes mellitus
- Stress
what are congenital heart defects
- Congenital heart defects are malformations of the heart or its major blood vessels that are present at birth.
what are the risk factors for congenital heart defects
- Viral infections during pregnancy, especially during the first trimester of pregnancy. Specifically, Rubella has been implicated, but other viruses, even common flu viruses, may cause defects in the developing foetus.
- Nutritional deficiencies during pregnancy.
- Exposure to environmental factors such as pesticides, toxins or radiation.
- Excessive consumption of alcohol during pregnancy.
- Maternal diabetes: women with diabetes mellitus are 5 times more likely to give birth to a baby with congenital heart disease than women who do not have it.
- Drugs (legal or illegal) and medication during pregnancy. Many pharmaceutical agents are not safe if taken during pregnancy, even over the counter drugs. As far as possible, pregnant woman should be advised to avoid medicines during pregnancy, if a medicine must be taken the patient’s doctor should prescribe it.
- Family history of congenital cardiac defects.
what are the classifications of congenital heart defects
Cyanotic- These are heart defects that manifest in cyanosis shortly after birth as the deoxygenated blood circulates to the arterial side of the circulation. Examples include tetralogy of Fallot, transposition of the great blood vessels.
Acyanotic- In these defects there is no evidence of cyanosis. These include septal defects, patent ductus arteriosus and coarctation of the aorta.
what is a septal defect
A septal defect refers to a hole in the septum that divides the right from the left side of the heart. Newborns can have ASD (Atrial septal defect) or VSD (Ventricular septal defect). The major presentations would be palpitations, irregular pulse, irregular contractions of the heart. Larger holes cause much more serious issues related to the heart and function of the heart.
what do cardiac glycosides eg digoxin do for cardiovascular conditions
Improve cardiac output by improving contractility and conductivity. slows down heart rate. usually used to treat atrial fibrillation
what do Diuretics eg furosemide do for cardiovascular conditions
Increase the excretion of sodium and water, thereby reducing oedema and circulatory overload. used to manage dyspnoea caused by cardiac failure to promote the excretion of excess fluid.
Has a onset of diuretic action and act primarily by inhibiting chloride and sodium reabsorption over the entire length of the thick ascending limb of the loop of Henle. the intravenous route is very fast acting in emergency situations such as pulmonary oedema.
reduces cardiac workload by reducing circulating volume.
what do vasodilators eg sodium nitroprusside do for cardiovascular conditions
Reduce peripheral vascular resistance, thereby improving blood flow through the periphery and improving venous return and lowering of blood pressure
Used in hypertensive emergency it is also used in selective patients with left ventricular failure associated with myocardial infarction or cardiac surgery in severe refractory heart failure caused by mitral or aortic valve incompetence and in uncontrolled heart failure and maybe used in control of dissecting aortic aneurysm
what do sympathiicolytics eg beta blocker agents (propanolol) do for cardiovascular conditions
Counteract the effects of the sympathetic nervous system, bringing about vasodilatation and reducing the blood pressure
what do ACE inhibitors eg captopril do for cardiovascular conditions
Prevent the conversion of angiotensin I to angiotensin II; this prevents vasoconstriction and prevents an increase in blood pressure
what do Antiarrythymias eg amiodarone do for cardiovascular conditions
Stabilise the cell membrane of cardiac muscle cells, thereby facilitating normal conduction and allowing the normal rhythm to reassert itself
what do Inotropic agents eg dobutamine do for cardiovascular conditions
Improve myocardial contractility and conducting ability in order to improve cardiac output
what do Thrombolytic agents eg streptokinase do for cardiovascular conditions
Cause lysis or breakdown of blood clots
what do cholesterol reducing agents eg clofibrate do for cardiovascular conditions
Bring about a reduction in blood cholesterol and lipid levels
what do Antiplatelet agents do for cardiovascular conditions
These agents reduce the tendency of platelets to clump together and trigger coagulation
what is stenosis of the valve
when the valve does not open fully and blood is not able to pass properly between chambers of the valve.
what is valve incompetance
when the valves cannot close properly and blood flows backwards.
atrial septal defect (ASD)
Presence of a hole in the septum that separates the right atrium from the left atrium, allowing the deoxygenated blood in the right atrium to mix with the richly oxygenated blood in the left atrium
Ventricular septal defect (VSD)
Presence of a hole in the septum that separates the right ventricle from the left ventricle, allowing the deoxygenated blood in the right ventricle to mix with the richly oxygenated blood in the left ventricle
Patent ductus arteriosus (PDA)
Failure of closure of a ductus arteriosus at birth
Coarctation of the aorta
Constriction of a segment of the aorta
Valvular stenosis and atresias
Incompetence of heart valves, resulting in regurgitation of blood or obstructed blood flow through the heart
Pulmonary artery atresia; pulmonary valve not formed properly
Tetralogy of fallot
Consists of four defects:
1. Ventricular septal defect (VSD)
2. Pulmonary stenosis
3. Overriding of the aorta
4. Hypertrophy of the right ventricle
Transposition of great arteries
The aorta arises from the right ventricle and the pulmonary artery from the left ventricle resulting in two circulations that are not connected
This defect is not compatible with life unless a connection between the two circulations is created immediately it is discovered at birth
what is right sided heart failure
-oedema in the legs and abdomen
what is left sided heart failure
-pulmonary oedema
Describe the nursing interventions required to manage dyspnoea caused by cardiac failure
Position the patient in high fowlers to allow for improved chest expansion/ improve ventilation.
Administer 40% oxygen therapy to increase oxygen and to decrease dyspnoea.
Monitor oxygen saturation to see effect of treatment.
Monitor respiration rate for rate rhythm and depth character to detect effect of treatment.
Administer diuretics as prescribed e.g. furosemide to promote the excretion of excess fluid.
Administer bronchodilators as prescribed e.g. aminophylline / salbutamol
Administer cardiac medication as prescribed eg digoxin to slow heart rate and improve contractibility.
Encourage deep breathing or coughing up the secretions to clear up the lungs, which will improve ventilation.
Describe the nursing interventions to manage oedema and ascites caused by cardiac failure. Always include the rationale.
Restrict fluids as prescribed to prevent increase in oedema/ to make sure intake does not exceed output
Strict monitoring of intake and output to see the effect of the treatment / to make sure intake does not exceed output
Do daily sacral / tibial (mention1) pitting oedema test to monitor response to treatment
Elevate legs to facilitate venous return / use cradle to keep weight off oedematous areas 4 hourly pressure care of oedematous areas to prevent skin break down
Implement a salt restricted diet to reduce fluid retention
Daily weights to measure effect of treatment
Daily girth measurements to evaluate effect of treatment
Administer diuretic as prescribed to remove excess fluid from the body. E.g. Furosemide.
Describe the nursing interventions required to manage chest pain caused by myocardial infarction.
Bed rest / quite environment to reduce cardiac demand / to reduce extension of the infarct
Oxygen therapy as prescribed. To reduce areas of ischaemia / to prevent extension of the infarct
Administer streptokinase as prescribed to dissolve the clot / to restore myocardial perfusion
Administer Nitrates as prescribed e.g. isordil to dilate the coronary blood vessels/ increase blood flow to the heart
Administer opioid analgesic as prescribed e.g. morphine for vasodilatory / calming effect.
Administer Calcium channel blockers as prescribed e.g. nifedipine to relieve the coronary artery spasm/ increase coronary artery blood flow
Administer Atenolol as prescribed to reduce excitability/ contractility of the myocardium.
Administer Aspirin as prescribed to reduce the coagulability of the blood
Ongoing assessment treatment of pain/ use of pain scales to determine the effectiveness of treatment.
what is angina pectoris
- it is a common symptom presenting among patients with CAD.
-it is a recurrent chest pain caused by myocardial ischaemia.
what is stable angina
-the attacks are related to known triggering factors.
-it is always relieved by rest and nitrates
-the duration and intensity of attacks is predictable
what is unstable angina
-the patterns of the attacks and triggering factors are unpredictable.
-the intensity and duration of the attacks has a tendency to increase.
-this type of angina is strongly associated with myocardial infarction.
with angina, describe the pathophysiology of the chest pain.
Because of the constriction of the coronary arteries in CAD, which is caused by atheromatus plaque build up in the arteries. this causes a decrease in blood supply to the myocardium which results in ischaemia, causing the chest pain.
what are the clinical manifestations of someone with PAD
pain
sores wounds or ulcers
blue or pale skin
temperature-cool
diminished hair and nail growth
gangrene
what is the pathophysiology of a deep vein thrombosis
-the deep vein lies at the centre of the leg, its surrounded by powerful muscles that contract and force blood back to the heart.
-however one way valves in the heart prevent back flow of blood between the contractions
-the blood is squeezed up in the leg and gravity and the valves prevent blood from flowing back to the feet
-therefore blood accumulates making the perfect site for blood clotting.
what are the risk factors for a deep vein thrombosis
History of previous deep-vein thrombosis
* Family history of deep-vein thrombosis
* Immobility, such as prolonged bed rest or sitting for
long periods of time in advancing age
* Following trauma or surgery
* Following orthopaedic surgery, especially of the hip
and knee
* Coagulation abnormalities
* Obesity
* During pregnancy and postpartum
* Certain malignancies, for example cancer of the
pancreas, lungs, genitourinary tract, stomach and breast are all associated with a high incidence of deep-vein thrombosis
* Certain forms of oral contraceptive, particularly those with high oestrogen content, have been associated with deep-vein thrombosis.
