week 4 cardiac 1 Flashcards
define heart failure
condition of impaired cardiac function due to a structural or functional disorder that decreases the ability of the ventricles to fill and eject.
as a result the heart cannot pump blood to the volume required to meet the blood pressure required
left sided heart failure symptoms (7)
- fatigue
- increased heart rate
- dysponea
- dry hacking cough
- crackles (APO)
- nocturia
- chest pain
right sided heart failure symptoms (7)
- fatigue
- increased heart rate
- oedema
- weight gain due to sodium and water retention
- nausea
- GI bloating
- ascities
- beahavoural changes
HF - Complications (5)
- pleural effusion
- arrhythmias
- left ventricular thrombus
- enlarged liver and impaired liver function
- renal failure due to chronic hypotension
HF - Diagnosis
- history and physically assessment
- echocardiogram (3D can measure size of the heart and look at how well it is contracting)
- chest xray (will see if the heart is enlarged)
- ECG
- bloods (U&E, LFT, Hb & ABG)
HF - Management (3 types)
*pharmacological management
first line treatment:
- ace inhibitor
- beta blocker
second line treatment:
- loop diuretic (frusemide)
- beta blocker
- ace inhibitor
- inotropic agents (adrenaline)
- fluid volume excess
- monitor UO
- fluid restriction (1 - 1.5L per day)
- low sodium diet
- daily weight
- Activity intolerance
- encourage gentle graded activity
- rest when needed
Pulmonary Oedema (define)
abnormal accumulation of fluid in the interstitial tissue and the aveoli of the lung
- fluid impairs gas exchange and lung expansion
APO - Causes
Cardiac:
- heart disease
- AMI
- Acute dysrithmia
Non Cardiac:
- blood transfusion fluid overload
- high altitude
APO - Clinical Manifestations
- altered concsuous state (aggressive, confused, agitated)
- SOB
- hypoxia
- increased WOB
- chest crackles on auscultation
- dullness to lung bases
- pink frothy sputum
- pale, diaphoretic skin
- pt may have feeling of impending death which is justified as untreated will lead to death
APO - Management
- Airway:
- Patent?
- Breathing
- RR, WOB, O2, ABG’s
- CXR
*Circulation:
- HR, BP, UO
- pathology (cardiac enzymes, FBE, U&E, ABG, lactate)
interventions:
- IDC
- careful fluid administration
- GTN
- diuretics
- morphine
- inotropes if hypotensive
*Disability
- GCS
- BGL
- Pain
- Temperature (may be cold)
interventions:
- nurse in fowlers position with legs dependant
CABGS (purpose)
aim is to construct a new vessel so that blood can be transported from the aorta to the myocardium
- the blocked artery is bypassed which means coronary perfusion is restored
CABGS - Indications
- unstable angina
- left main corarny artery disease
- treatment of MI or HF
- complications from PCI
Viens vs, Arteries
Arteries:
- can use mammary or radial artery
- risk of vasospasm
- takes longer to re stenose
- patency of 90% at 10 years
Veins:
- can use saphenous veins
- no vasospasm
- 3X quicker to re stenose
- patency of 60% after 10 years and likely to need redoing after 5 to 10 years
artery grafts are the way to go these days!
CABGS - Complications (5)
- bleeding
- cardiac tamponade
- arrhythmias
- electrolyte and metabolic distrubances (hypokalemia, Hyperglycaemia)
- pleural effusion
- pain
CABGS - Management
post op > 24hrs in ICU (intubated & haemodynamic monitoring)
Danger:
- bedside area prepared & emergency equiptment
Response:
- AVPU
Breathing :
- pt intubated and ventilated for upto 24hrs post op
- chest ausculatation
- CXR
- 2 UWSD
- ABG’s
Circulation:
- close of monitoring haemodynamic status
- care of pt lines (CVC)
- ECG baseline and review 12/24
- monitor UO
Disability: - GCS - BGL - Pain - Temp interventions: - analgesia (sternum may be painful due to having to open up chest during surgery) - aspectic dressing (infection in the sternum very hard to treat)
