CARE OF PATIENTS WITH CARDIAC PROBLEMS

Question 1

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

Answer 1

Pulm edema

Question 2

Severe HF (with fluid overload)
Acute myocardial infarction (MI)
Mitral valve disease
Dysrhythmias

Answer 2

Causes/results from:

Question 3

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

Answer 3

Symp of pulm edema

Question 4

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

Answer 4

Pulm edema interventions

Question 5

Maintain oxygen saturation above 90%

Answer 5

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

Question 6

CPAP, BiPAP, or intubation and mechanical ventilation - collab with RT, physician and monitoring pat to determine level of intervention needed

Answer 6

Aggressive pulmonary therapy

Question 7

CPAP, BiPAP, or intubation and mechanical ventilation - collab with RT, physician and monitoring pat to determine level of intervention needed

Answer 7

Aggressive pulmonary therapy

Question 8

if systolic BP is greater than 100

Answer 8

Nitroglycerin (NTG) - sublingual - q5min for up to 3 doses to decrease afterload and preload

Question 9

IV Furosemide (Lasix) or Bumetanide (Bumex): push/drip; push first then starting drip for continuous fluid removal

Answer 9

Administer rapid-acting diuretics - remove fluid

Question 10

Inadequate BP: decreases preload
Reduces venous return (preload)
Decreases anxiety
Reduces work of breathing

Answer 10

IV Morphine Sulfate

Question 11

Acquired valvular dysfunctions:
Key features:
Diagnostic testing:
Management of heart disease depends on which valve is affected and the degree of valve impairment

Answer 11

Valvular heart disease

Question 12

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

Answer 12

Mitral stenosis

Question 13

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

Answer 13

Mitral regurgitation (insufficiency)

Question 14

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

Answer 14

Mitral valve prolapse

Question 15

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

Answer 15

Aortic stenosis

Question 16

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

Answer 16

Aortic Regurgitation (insufficiency)

Question 17

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

Answer 17

Key features:

Question 18

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

Answer 18

Diagnostic testing:

Question 19

Nonsurgical management
Surgical management
Patients with defective or repaired valves are at risk for infective endocarditis, require prophylactic antibiotic therapy before any invasive procedure

Answer 19

Management of heart disease depends on which valve is affected and the degree of valve impairment

Question 20

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

Answer 20

Nonsurgical management

Question 21

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;

Answer 21

Surgical management

Question 22

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:

Answer 22

Infective endocarditis

Question 23

most common infective organism Streptococcus viridans or Staphylococcus aureus

Answer 23

Infection of the endocardium

Question 24

IV drugs use
Valve replacements
Systemic infection - alterations in immunity
Structural cardiac defects

Answer 24

Causes/most in pats:

Question 25

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)

Answer 25

Possible ports of entry for infection

Question 26

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)

Answer 26

Key features: CM:

Question 27

Heart failure - right/left
Arterial embolization - major comp - fragments of vegetations/clots break loose and travel through circ

Answer 27

Complications:

Question 28

positive blood cultures
echocardiogram (evidence of endocardial involvement)

Answer 28

Diagnostic assessment:

Question 29

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

Answer 29

Interventions:

Question 30

Inflammation or alteration of the pericardium (the membranous sac that encloses the heart) - associated with infective organisms
Features/assessment:
Interventions:

Answer 30

Acute pericarditis:

Question 31

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

Answer 31

Features/assessment:

Question 32

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)

Answer 32

Interventions:

Question 33

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

Answer 33

Cardiomyopathy

Question 34

In rare cases tissue is replaced with scar tissue

Answer 34

Heart muscle becomes enlarged, thick, or rigid

Question 35

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

Answer 35

Treatment