Week 2 Cadiac Flashcards
Afterload
The amount of pressure that the heart needs to exert/eject the blood during ventricular contraction
Cardiac Output
Volume of blood pumped by the heart in one minute
Ejection Fraction
The % of blood pumped out of left ventricle with each contraction
Normal >50%
Less than 40% = HF
Hypertension
HTN = high blood pressure
Causes adverse effects on arterial walls: ⬆️ PVR
Untreated, causes ⬇️ blood flow
Silent killer
Diagnose: average of 2 or more readings on at least two subsequent health care visits above 120/80
Hypotension
SBP <90 mm/hg
Drop in BP, organs are not getting perfused
Infarction/necrosis
Obstruction of blood supply to an organ or region of tissue causing death to the tissue
Ischemia
Inadequate blood supply to an organ or part of the body, especially heart
Myocardial contractility
How hard the heart muscle contracts
Orthostatic hypotension
Drop in BP when someone goes from sitting to standing
SBP - ⬇️ 20 mmHg or more
DBP - ⬇️ 10 mmHg or more
Measure BP within 1-3 minute of position changes
Preload
The amount of stretch experienced by the heart at the end of ventricle filling (EDV) during diastole.
Pulmonary embolism
Blood clot that’s traveled to the lung
Pulse pressure
Difference between SBP and DBP
Normal 1/3 of SBP
High?
- atherosclerosis
- exercise
Low?
- severe HF
- hypovolemia
Pulsus Alternans
Regular rhythm but strength of pulse varies with each beat
Possible etiology: HF
Stroke
Blood clot in the brain
Stroke volume
Volume of blood pumped out of the LEFT ventricle of the heart during SYSTOLE
Venous thrombo-embolism
Who’s at risk?
S/S?
Nursing care?
Treatment?
Obstruction of a blood vessel by a blood clot that has become dislodged from another cite in the circulation
Most commonly starts in the legs and moves to the lungs (pulmonary embolism)
Who’s at risk?
- Venous stasis (pregnant, blood pooling, immobile)
- Hypercoagulability (thickened blood, dehydrated, BC,
platelet disorders)
- Endothelial damage (IVF, drugs, fractures, hx of DVT, DM)
S/S?
- redness, tenderness, swelling, warm, unilateral, calf pain
Nursing care?
- Teds, SCDs, Calf pumping
Treatment?
- Prevention
- IVC filter (catches clot before lungs)
- Anti-Coag meds
- Thrombolytics
Perfusion
Passage of fluid through the circulatory system or lymphatic system to an organ or tissue
Things that affect cardiac output
- Heart rate
- Stroke volume
- Myocardial contractility
Blood pressure
Force exerted by the blood vessel walls
- Must be adequate to maintain tissue perfusion during
activity and rest - Need to know patient’s baseline BP
Cardiopulmonary Resuscitation (CPR)
When is it needed?
- No pulse, no RR
C-A-B
- Early defibrillation
Rate of compressions
- 30 to 2 (compressions to breaths)
- 100 - 120 compressions
Depth of compressions
- 2 inches
C.A.B.
Compressions
Airway
Breathing
Peripheral Vascular Resistance (PVR)
Amount of effort the heart has to overcome to get the blood out of the heart and into the periphery
Blood Pressure Categories
Normal——————— <120 AND <80
Elevated——————- 120-129 AND <80
HTN stage 1 ————- 130-139 OR 80-89
HTN stage 2 ————- 140⬆️ OR 90⬆️
Hypertensive crisis —- 180⬆️. AND/OR. 120⬆️
Factors influencing BP
Age, stress, ethnicity, genetics, gender, daily variation, medications, activity, weight, smoking
Modifiable risk factors with BP
DM, elevated serum lipids, excess Na+ intake, obesity, sedentary lifestyle, stress, smoking, alcohol
Non-Modifiable risk factors with BP
Family history, race/ethnicity, increasing age, gender, chronic kidney disease, OSA
HTN symptoms
Dizziness, headache, heart palpitations (NOT INCREASED HR), nose bleeds, SOB, anger, red face, visual problems, fatigue, insomnia, sore knee, raised temp.
Complications of HTN
Cardiovascular dz, MI (heart attack), stroke, peripheral vascular disease, renal dz, retinal dz
Nursing care & Treatment for BP
- BP management
- implement pt centered plan for lifestyle modifications
- goal: prevent heart dz, stroke, or renal dz
- promote heart healthy nutrition
- weight reduction
- smoking cessation
- pt. education
Patient education
- develop a BP screening program based on BP
- explain potential dangers
- manage HTN
- lifestyle modifications
- proper nutrition
- exercise
- stress management techniques
- drug therapy education
- seek immediate care if in HTN crisis
Hypertensive crisis
HTN urgency
- develops over days to weeks
- 180/110
- NO SYMPTOMS
HTN emergency
- develops over hours to days
- 220/140
- SYMPTOMS
- IV meds
Foods high in salt
Cheese, saltines, condiments, pickles
Symptoms of HoTN
Pale skin, skin mottling, clammy, decreased perfusion to the brain, dizziness, confusion, blurred vision, chest pain, increased HR, decreased UO, N/V
Treatment of HoTN
Treat the cause:
- Vasodilation
- Loss of blood volume
- Failure of heart muscle to pump
Nursing implementation: HoTN
- Monitor VS frequently
- Assess for symptoms
- Interventions aimed to treat the cause
- Consider adding more salt to diet
- Drink more water or IVFs
- Compression hose
- Meds
Hyperlipidemia
High lipid levels in the body
Hyperlipidemia Nursing Care
- Check, change, control
- Maintain healthy weight
- Be active
- Limit smoking and alcohol
- Dietary modifications
- Meds
Dietary modifications for HLD
- Reduce saturated fats and trans fats
- Increase complex carbs and fiber
- Limit major sources of cholesterol
- Limit alcohol & simple sugars if you have ⬆️ TGs
- Eat fatty fish weekly
- Foods high in omega-3 fatty acids (nuts)
Complete Blood Count
Hgb & Hct
Hgb - iron containing pigment
—> F (12-16) M (14-18)
Hct - % total volume of blood made up of RBCs
—> F (37-47%) M (42-52%)
Electrocardiogram
ECG
Normal sinus rhythm
- originates in SA node
P wave
PR interval
QRS complex
QT interval
Electrodes/Tele
“Snow over grass”
“Smoke over fire”
“Chocolate next to my heart”
Nursing problems r/t cardiac
- unstable BP
- activity intolerance
- decreased CO
- decreased tissue perfusion
- fatigue
- impaired gas exchange
- ineffective airway clearance
- fluid volume excess or deficit
- risk for injury (Orthostatic HoTN)
Nursing Assessment r/t cardiac
- inspection and palpation
- auscultation
- history of heart assessment
- assess and monitor VS and O2 sats
- skin
- changes in LOC
- peripheral pulses
- calf tenderness
- edema
- JVD (jugular venous distention, 45 degree
Nursing Assessment - Heart sounds
S1 — normal, lub
S2 — normal, dub
S3 — “ventricular gallop” — “Ken-TUCK-y”
S4 — “atrial gallop” — “TEN-nes-see”
Murmurs:
Location, radiation, loudness, pitch, quality, systolic vs diastolic
Clicks:
Mechanical valve, metal comes together
Rubs:
Pericardial sac, sounds scratchy
5-Ps
P - Pain P - Pulse P - Pallor P - Paresthesia P - Paralysis
Cardiac Nursing Implementation
- Strict I&O
- Monitor labs
- Oxygen prn
- Tele
- Heart healthy diet
- Limit stress
- Meds
- Prevent thrombus formation
Nursing Care: Pt Teaching
- Pt centered plan
- Goals & resources
- Avoid smoking and alcohol
- Limit stress
- Control HTN, HLD, DM
- Nutrition
- Exercise
Nursing care: Evaluation
- Evaluate progress
- Meet goals?
- If no, what is your next step to help them obtain their goal?
