Class 1 nursing management and interventions in CV Flashcards
HTN management
-DASH diet
-Low sodium diet 1200-1500 mg with max of 2000 mg per day
-Healthy body weight and moderate exercise activity
-Limit alcohol consumption and tobacco use
-Stress management
HTN drug management
-Multiple drugs often used, especially with Type 2 diabetes
-Replace multiple antihypertensive agents with single pill combination therapy
-Single pill combinations or monotherapy should be considered for initial antihypertensive therapy.
-Low doses of multiple drugs may be more effective and better tolerated than higher doses of fewer drugs
-Don’t mix ACE&ARBs
-In combination therapy, an ACE inhibitor plus a long-acting dihydropyridine CCB is preferred
Hypertensive crisis
-Severe and abrupt
-Treatment goals is to decrease MAP to 10-20% in first 1 to 2 hours, with gradual reduction in the next 24 hours
Hypertensive emergency IV medications
-Vasodilators (sodium nitroprusside*, nitroglycerin, hydralazine)
-Adrenergic inhibitors (phentolamine, labetalol, esmolol)
-Ace Inhibitors (Enalapril)
Nursing considerations in hypertensive emergency
-Monitor BP with an art line
-Continuous ECG monitoring to observe for dysrhythmias
-Hourly urine output
-Bed rest to avoid cerebral ischemia and fainting
Hypertensive emergency therapy goals
-Minimize end-organ damage (cardiac, renal, respiratory, and retinal damage), maintain adequate perfusion with special assessment of neuro, cardiac, and renal monitoring
Hypertensive urgency
-Can be managed with PO medications (captopril and clonidine)
Acute hypertension
-Evidenced by hypoperfusion to the brain, heart & kidneys
Acute hypotension caused by blood or fluid loss tx
-IV fluids, blood, or blood products
Acute hypotension caused by primary CV dysfunction tx
-AMI, cardiac tamponade & pulmonary embolism will result in a fall in CO and may need drug intervention
Acute hypotension caused by secondary CV dysfunction tx
-Result of negative chronotropic & inotropic effects caused by beta blockers, digoxin, or opioids and may need to administer vasoconstrictive agents
Non-cardiac factors causing decreased O2 supply
-Anemia
-Low blood volume
-Hypoxemia
-Pneumonia
-Asthma
-COPD
Non-cardiac factors that increase myocardial O2 demand
-Anxiety
-Cocaine
-Physical exertion
-HTN, hyperthermia, hyperthyroidism
Cardiac factors that decrease O2 supply
-Coronary artery spasm & thrombis
-Dysrhythmias
-HF
-Valve disorders
Cardiac factors that increase O2 demand
-Aortic stenosis
-Cardiomyopathy
-Dysrhythmias
-Tachycardia
Angina goal of treatment
-Improve perfusion, and reduce pain through vasodilation
-Also with use of antiplatelet and cholesterol lowering drug therapy
Pneumonic for treatment of stable angina
-A; Antiplatelet agent, antianginal, ACE I
-B; Beta-adrenergic blockers, BP
-C; Cigarette smoking, cholesterol
-D; Diet, diabetes
-E; Education, exercise
-F; Flu vaccination
Coronary artery disease management: Diagnostic testing
-Stress test: Outpatient procedure, non-urgent
-Echocardiogram
Acute coronary syndrome: Serum cardiac markers after AMI
-Full Electrolyte Panel with focus on: Sodium, potassium, magnesium
-Lipid Panel: Total Cholesterol, triglycerides, HDL, LDL
-Creatinine, BUN
-Blood Glucose
-B-Type (Brain-type) Natriuretic Peptide
Acute coronary syndrome and unstable angina
-Unstable lesion that may be partially blocking coronary artery (unstable angina (UA) or NSTEMI) or totally blocking coronary artery (STEMI)
-Chest pain that is new in onset, occurs at rest, or has a worsening pattern is unstable angina
Unstable angina treatment
-Anticoagulant therapy (IV or SC Heparin)
-Antiplatelet therapy (ASA)
-Antihypertensive to manage myocardial demand (Beta blockers, Ace Inhibitors, Statin)
Pain management in acute coronary syndrome and unstable angina
-Rapid acting SL nitro spray for chest pain, if that does not work then IV nitro
-Must be in a critical care area to be monitored for continuous ECG and BP; morphine and supplemental oxygen if needed
Acute coronary syndrome diagnostic tests
-Angiogram
-Angioplasty
Post angiogram/angioplasty management
-Fibrinolytic therapy
-Coronary revascularization: Angiogram, balloon angioplasty, Percutaneous Coronary Insertion (PCI), stents, patient must be immobile prior to procedure, mark pulses with a marker
Fibrinolytic therapy indications
-Tx of ST elevations, stroke, DVT or PE
Fibrinolytic therapy contraindications
-Aortic dissection
-Internal bleeding
-Intracranial tumor
-Pericarditis
Fibrinolytic therapy procedure purpose
-Dissolves blood clots
Angiogram/angioplasty post procedural care
-May be on class IIb/IIIa Inhibitors; reperfusion dysrhythmias
-ASA, Beta, “Pril”, Statin and Plavix if PCI
-Fluids as patient may be bleeding or hypotensive
-Palpate pulses distal to insertion site
-Auscultate insertion site for a bruit
-Ambulation
Post procedure care following a CABG
-Pulmonary artery catheter for measuring CO, other hemodynamic parameters
-Art line for continuous BP monitoring
-Chest tube for drainage
-Continuous ECG monitoring to detect dysrhythmias (esp. atrial dysrhythmias)
-Endotracheal tube/mechanical ventilation: extubate within 12 hours
-Epicardial pacing wires for emergency pacing of the heart
-Monitor urine output
-NG tube for gastric decompression
Post procedure care following CABG
-Monitor for bleeding, fluid, electrolyte imbalances, hypothermia (blood is cooled in bypass machine), & issues with the bypass machine
-Replacing electrolytes PRN
-Restoring temperature (e.g., warming blankets)
-Monitoring rhythm, BP, and CO
-Assist with ambulation
Management of dysrhythmias
-Transcutaneous pacemaker
-Permanenet pacemaker
Management of sinus tachycardia
-B-adrenergic blockers to reduce HR and myocardial oxygen consumption
-Antipyretics to treat fever
-Analgesics to treat pain
Management of common dysrhythmias + TEE
-Patients may need a transesophageal echocardiogram (TEE) prior to cardio version
Pulseless electrical activity 6 H’s & 6T’s
-Hyperkalemia, hydrogen ion excess, hypovolemia, hypoxia, hypothermia, hypoglycemia
-Tampanode, tension pneumothorax, thrombis (PE), thrombus (MI), toxins, trauma
Implantable cardioverter-defibrillator (ICD)
-Appropriate for patients who:
-Have survived SCD
-Have spontaneous sustained VT
-Have syncope with inducible ventricular tachycardia/fibrillation during EPS
-Are at high risk for future life-threatening dysrhythmias
-Consists of a lead system placed via subclavian vein to the endocardium
Implantable cardioverter-defibrillator (ICD) nursing considerations and pt teaching
-Fear of body image change & recurrent dysrhythmias
-Expectation of pain with ICD discharge
-Anxiety about going home
-Participation in an ICD support group should be encouraged.
