CARE OF PATIENTS WITH CARDIAC PROBLEMS Flashcards
Want to avoid in HF pats
Acute Life-threatening event
Causes/results from:
Need do intervention quickly
With this Left ventricle fails to eject sufficient amount of blood and backs up into lungs and pressure increases in the lungs
The increased pressure causes fluid to leak across the pulmonary capillaries and into the lung airways and tissues
Pulm edema
Severe HF (with fluid overload)
Acute myocardial infarction (MI)
Mitral valve disease
Dysrhythmias
Causes/results from:
Crackles - early sign
Dyspnea - early sign
Disorientation or acute confusion - early sign: Increased in older adult
Tachycardia - often occurs
Hypertension or hypotension
Reduced urinary output
Cough with frothy, pink-tinged sputum - moist productive cough
Premature ventricular contractions and other dysrhythmias
Anxiety - typ extremely anxious; really struggling for air which increases anixety; can know coming on and becoming anxious
Restlessness
Lethargy
Skin cool, clamy, cyanotic
PVCs, dysrhythmias
Symp of pulm edema
Need do intervention
Monitor VS - BP changes, tachycardiac, look at O2 level
If not hypotensive, place in high Fowler’s position - legs down to decrease venous return to heart
High flow oxygen therapy - priority O2 nursing action is keep O2 sat above 90% and high flow O2 therapy: non-rebreather/high-flow nasal cannula - may need more aggressive pulm therapy
Aggressive pulmonary therapy
Nitroglycerin (NTG) - sublingual - q5min for up to 3 doses to decrease afterload and preload
Administer rapid-acting diuretics - remove fluid
IV Morphine Sulfate
Closely monitor VS - make sure interventions working or need change
Pulm edema interventions
Maintain oxygen saturation above 90%
High flow oxygen therapy - priority O2 nursing action is keep O2 sat above 90% and high flow O2 therapy: non-rebreather/high-flow nasal cannula - may need more aggressive pulm therapy
CPAP, BiPAP, or intubation and mechanical ventilation - collab with RT, physician and monitoring pat to determine level of intervention needed
Aggressive pulmonary therapy
CPAP, BiPAP, or intubation and mechanical ventilation - collab with RT, physician and monitoring pat to determine level of intervention needed
Aggressive pulmonary therapy
if systolic BP is greater than 100
Nitroglycerin (NTG) - sublingual - q5min for up to 3 doses to decrease afterload and preload
IV Furosemide (Lasix) or Bumetanide (Bumex): push/drip; push first then starting drip for continuous fluid removal
Administer rapid-acting diuretics - remove fluid
Inadequate BP: decreases preload
Reduces venous return (preload)
Decreases anxiety
Reduces work of breathing
IV Morphine Sulfate
Acquired valvular dysfunctions:
Key features:
Diagnostic testing:
Management of heart disease depends on which valve is affected and the degree of valve impairment
Valvular heart disease
Narrowing of valve opening
Valve opening narrowed preventing norm blood from LA to LV and LA pressure increases and dilates and pulm artery pressure increases causing RV to hypertrophy/increase in side causing/Causes pulmonary congestion and right heart failure
Mitral stenosis
Valve does not completely close during systole
Prevents mitral valve from closing completely
Blood backs up into LA when LV contracts; during diastole blood flows into LA and increased blood needs to be ejected in next systole cycle - to compensate for increased blood volume and pressure - LA and LV dilate and hypertrophy
Backflow of blood into the left atrium
Mitral regurgitation (insufficiency)
Valvular leaflets enlarge and prolapse into the left atrium during systole
Usually benign - can adv to mitral regurgitation
Associated with congenital cardiac defects and does have family tendency
Mitral valve prolapse
Most common cardiac valve dysfunction
Orifice Narrowing of valve opening and obstructs LV outflow during systole
Increased resistance to ejection of blood/afterload and cardiac output is decreased and fixed - results in hypertrophy; as stenosis worsens, CO fixed and cannot increase to meet needs of body during exercise - overtime LV fails and blood backs up into LA and pulm sys becomes congested
Aortic stenosis
Valve does not close completely during diastole
Aortic leaflets not close properly
Backflow of blood into the left ventricle
Compensate: LV dilatees to accommodate greater blood volume and eventually hypertrophies
Aortic Regurgitation (insufficiency)
Depends on valve damage and type dysfunction has with valve
Fatigue - common: decreased CO
Dyspnea - common: pulm congestion; decreased CO
Angina - atypical: decreased blood flow to certain parts of the heart
Dysrhythmias - afib
Edema - RHF
Key features:
Echocardiogram – procedure of choice: noninvasive: visualize structure and movement of heart and see areas damaged
Transesophageal echocardiogram (TEE) - more invasive - used assess valve probs
Chest x-ray - show if heart structures enlarged or if pulm congestion
ECG - assess abnormalities because afib common in valve disorders
Diagnostic testing:
Nonsurgical management
Surgical management
Patients with defective or repaired valves are at risk for infective endocarditis, require prophylactic antibiotic therapy before any invasive procedure
Management of heart disease depends on which valve is affected and the degree of valve impairment
Involves Medications: diuretics, beta blockers, ACE inhibitors, digoxin, O2 therapy: improve symp of HF; nitrates and vasodilators may be used
Irregular heart rhythm drug therapy to control HR to get back to NSR: diltaizem/amiodiorone
Valvular heart disease and afib: anticoag included
Nonsurgical management
Replacement or repair
invasive/perivative procedure of valve(s)
Replacement: prostethetic/synthetic - each has adv and dis that need be discussed; biologic: from pig/cow;
Surgical management
Infection of the endocardium
High mortality rate
Early detection is very essential
Causes/most in pats:
Possible ports of entry for infection
Key features: CM:
Complications:
Diagnostic assessment:
Interventions:
Infective endocarditis
most common infective organism Streptococcus viridans or Staphylococcus aureus
Infection of the endocardium
IV drugs use
Valve replacements
Systemic infection - alterations in immunity
Structural cardiac defects
Causes/most in pats:
Oral cavity (if dental procedures have been performed)
Skin rashes, lesions, abscesses
Infections (cutaneous, genitourinary, GI, systemic)
Surgery or invasive procedures, including IV line placement (central lines)
Possible ports of entry for infection
s/s usually occur within 2 weeks; mortality rate high early detection essential
Fever associated with chills, night sweats, malaise, fatigue
Anorexia and weight loss
Cardiac murmur
Petechiae (pinpoint red spots)
Splinter hemorrhages (black longitudinal lines or small red streaks on the distal third of the nail bed)
Key features: CM:
Heart failure - right/left
Arterial embolization - major comp - fragments of vegetations/clots break loose and travel through circ
Complications:
positive blood cultures
echocardiogram (evidence of endocardial involvement)
Diagnostic assessment:
IV antimicrobials for 4-6 weeks - drug choice depends on organism shown by blood culture
Rest - adequate; cont assess for s/s for HF
Surgical management if antibiotic therapy is ineffective - HF develops to infected valve, large valvular vegetation or multiple embolic events occur; replacing/repairing infected/injuring valves, draining abscesses, repairing/removing congenital shunts
Interventions:
Inflammation or alteration of the pericardium (the membranous sac that encloses the heart) - associated with infective organisms
Features/assessment:
Interventions:
Acute pericarditis:
Substernal precordial pain that radiates to the left side of the neck, shoulder or back
Pain is grating and oppressive and aggravated by breathing (mainly inspiration), coughing, and swallowing - worse supine and relieved in tripod
Pericardial friction rub - left lower sternal border
Fever with elevated WBC
Features/assessment:
Pain management (NSAIDs)
Corticosteroids - not have bacterial pericarditis
IV antibiotics
May require pericardial drainage
Avoid aspirin and anticoagulants - increase risk of cardiac tamponade (excessive fluid in pericardial cavity)
Interventions:
Subacute or chronic disease of cardiac muscle
Heart muscle becomes enlarged, thick, or rigid
High mortality rate for patients who develop heart failure
4 types/categories on the basis of abnormalities in structure and function
Treatment
Cardiomyopathy
In rare cases tissue is replaced with scar tissue
Heart muscle becomes enlarged, thick, or rigid
Varies with the type of cardiomyopathy
Nonsurgical Medical treatment includes medications similar to those for heart failure and dysrhythmias: diuretics, vasodilators, cardiac glycosides, antidysrhythmic and ICD - fatal dysrhythmias, beta blockers, Ca antagonists
Surgical interventions: Treatment of choice with severe cardiomyopathy is heart transplant
Treatment
