Chapter 26 Cardiovascular Flashcards
Preload (2)
- degree of stretch of cardiac muscle fibers at end of diastole
- force needed for the heart to actually beat
After load (2)
- resistance to ejection of blood from ventricle
- how much force needed to force the blood out of the heart
Client Preparation before Undergoing Cardiac Catherization (5)
- obtain written consent
- ensure preprocedure labs are drawn as prescribed (BUN and creatinine- these assess kidney function for excretion contrast); client will receive heparin during procedure (aPTT, PT, or INR)
- contraindication: SHELL FISH ALLERGY
- Metformin must be stopped 48 hours before and after procedure
- explain the pt will be awake and may experience flutter feeling
- *NPO after midnight
Postprocedure Nursing Care after Undergoing Cardiac Catherization (6)
- maintain “flat” bed rest for 4-6 hours (risk for hematoma to the site)
- maintain pressure dressing at insertion site
- monitor BP (drop in BP indicates bleeding), HR (tachycardia indicates bleeding), color and temp of extremeties, assess for signs of bleeding at site
- if bleeding occurs, apply manual pressure
- increase fluid intake (contrast dye secreted through the kidneys)
- monitor I & O’s
Chronic Stable Angina Pectoris
- temp imbalance between the coronary aretery’s ability to supply oxygen and the cardiac muscles’s demand for oxygen
- ischemia (lack of oxygen to the tissue) limited in duration and does not cause permanent damage to the myocardial tissue
Three Types of Angina
- Stable
- Unstable
- Variant
Stable Angina (2)
- relieved by rest or nitro
- can be caused by stress or exercise
Unstable Angina
-preinfaractiojn (pt sitting watching tv and all of a sudden has chest pains)
Variant Angina
-directly related to a coronary artery spasm
Characteristics of Angina (4)
- precipitated by exertion or stress
- relieved by rest or nitroglycerin
- symptoms last less than 15 minutes
- NOT associated with nausea, epigastric distress, dyspnea, anxiety, diaphoresis (these are more MI symptoms)
Nursing Care of Patients with Chest Pain (4)
- EKG monitoring (usually within 10 minutes of complaint of chest pain)
- vital signs (oxygen saturation should be about 95%)
- may need to call RRT (rapid response team)
- medications (aspirin-may have pt chew to have a quicker response to the body and nitrates)
Nitroglycerin (4)
- 1st thing we assess are ABC’s (airway, breathing and circulation)
- medication of choice in treating angina pain
- vasodilator: causes hypotension and splitting headache
- decreased preload and afterload causes a decrease in O2 demand in the heart
- tablets are sensitive to light
Symptoms of Women with Impending MI (4)
- jaw pain
- neck pain
- back pain
- increased anxiety
Angio Plasty
- more in-depth cardiac catherization
- inflating a balloon to dilate the arterial lumen (stent)
- helping to perfuse the heart
- complications: plaque against walls of blood vessel can cause both stoke and pulmonary embolism potential; plaque can become dislodged
Coronary Stent
-nursing consideration for pre and post-procedure
- Pre-procedure: NPO after midnight, allergy assessment to iodine
- Post-Procedure: monitor vital signs, distal pulses, bed rest, heparin
Coronary Artery Bypass Graft (CABG) (5)
- there is a major type of blockage, a stint is not going to work, and basically the obstructive area needs to be bypassed
- restores myocardial tissue perfusion
- most common form of cardiac surgery
- graft taken from leg (saphenous vein)
- patient will be in critical care
CABG Post-Op Considerations (8)
- infection
- mechanical ventilation
- vital signs
- chest tubes
- fluid and electrolyte embalance (want potassium level around 3.5 mEq/L)
- hypotension (can collapse the vein graft)
- hypertension (can explode the vein graft)
- incentive spirometry- help bring sections up and expand the lungs
Heart Failure (2)
- heart is unable to pump sufficient blood to the meet the needs of the tissues for oxygen and nutrients
- characterized by fluid overload or inadequate tissue perfusion
- myocardial disease in which there is a problem with the contraction of the heart (systolic failure) or filling of the heart (diastolic failure)
Right-sided heart failure
-clinical manifestations
RV cannot eject enough blood and the blood backs up in the venous system
Left-sided heart failure
-clinical manifestations
LV cannot pump blood effectively to the systemic circulation; pulmonary venous pressures increase and result in pulmonary congestion
Symptoms of Right Sided Heart Failure (7)
“Every Dog Always Watches Digging In Africa”
- Enlarged liver & spleen
- Distended jugular veins
- Anorexia & complaints of GI distress
- Weight gain
- Dependent edema
- Increase peripheral venous pressure
- Ascites (accumulation of fluid in the peritoneal cavity)
Symptoms of Left Sided Heart Failure (7)
“Eating Rice That Contains Carrots Offends Pigs”
- External dyspnea (due to sputum)
- Restlessness
- Tachycardia & tachypnea
- Cyanosis
- Confusion
- Orthopnea
- Pulmonary congestion
Laboratory and Diagnostic Testing for Heart Failure (4)
- Human B-type natriuretic peptides:levels indicate the degree of severity
- Utrasound: function of the heart, ejection fraction measurement
- Chest X-Ray
- Electrocardiogram
Nursing Interventions for Patients with Heart Failure (5)
- daily weights
- SOB (oxygen and maximize ventilation)
- vital signs
- bed rest (energy conservation)
- dietary restrictions (avoid sodium)
Medications used for Heart Failure (5)
- ACE Inhibitors
- Beta Blockers
- Calcium Channel Blockers
- Diuretics
- Inotropic Agents
Activity Intolerance for Patients with Heart Failure (7)
- bed rest for acute exacerbations
- encourage regular physical activity (30-45 mins/day)
- pacing of activites
- wait 2 hours after eating for physical activity
- avoid activities in extreme hot, cold, or humid weather
- modify activities to conserve energy
- positioning (elevate HOB to facilitate breathing and rest; support of arms)
