Week 8: CIRCULATION & PERFUSION II Flashcards
Coronary Artery Disease (CAD)
Narrowing or obstruction of the coronary arteries as a result of atherosclerosis
Buildup of plaque in arterial walls
- Caused by injury to artery walls (HTN, diabetes, inflammation, high cholesterol)
- Plaque impacts perfusion, causing damage to body systems
Assessment of CAD
Health history:
Family history, Age (increased with age), Gender (women after menopause), Genetics, SDOH, Stress, Alcohol, Smoking, Depression, Signs and symptoms, Comorbidities – HTN, dyslipidemia, diabetes, high BMI
Physical:
Neuro – fatigue, dizziness, anxiety, insomnia
Cardiac – chest pain, cardiac events (palpations, sensations)
GI – indigestion
Labs/Investigations: Coronary artery disease
Lipid profile (normal values):
Total cholesterol = under 200
LDL (bad) = under 100
HDL (good) = over 60
Triglycerides = under 150
HbA1C (uncontrolled diabetes)
High = increased risk
BG (uncontrolled diabetes)
High = increased risk
Nursing priorities of CAD
- Control cholesterol
- Medication
- Lifestyle changes (low sugar, low saturated fats, high fibre diet)
Manage comorbidities
- Promote blood glucose control
- Promote blood pressure improvement
Health teaching
- Treatment/lifestyle modifications o Interprofessional team (RD)
Stenosis
Occurs as a progression of CAD
Stages:
- Clear vessel
- 50% block
- 80% block – blood flow here might be enough during rest when HR is stable, but
when HR increases to meet the demands of activity, not enough blood flow will cause starvation of tissues- May see symptoms in this stage
Myocardial Infarction and Angina
Conditions of myocardial ischemia (reduced blood flow to heart muscles)
- Demand for O2 is greater than the supply of O2
Angina
ischemia of partial thickness of myocardial muscle
- Chest pain brought on by myocardial ischemia
Stable – predictable, occurs with exertion, relieved w rest and nitroglycerin
Unstable – unpredictable, occurs w/o exertion, not relieved w rest and nitroglycerin
causes of angina
Stenosis
Vasospasm
Thickening of heart wall
tests for angina
Negative Cardiac Biomarkers
Negative ECG
Nursing priorities: Angina
Pain management & promote perfusion:
- Medication (nitroglycerin), lifestyle changes
PROCESS:
- Stop activity
- Sit in semi-fowlers
- Assess pain
- Administer nitroglycerin
- Re-assess pain
- VS and cardiac assessment
- Apply O2
- Re-assessment
Pharmacological Interventions: angina
(target vasodilation, pain relief, and reduce risk of clotting/atherosclerosis):
Nitrates (short acting, long acting)
Calcium channel blockers
Beta blockers
Antihyperlipidemics (statins)
Anti-coagulants
MI - Myocardial infarction
ischemia of full thickness of myocardial muscle
- Death of myocardia cells as a result of prolonged ischemia
- EMERGENCY SITUATION
Causes and treatments for MI
Causes:
Stenosis
Plaque
Lodge
Goal - restore blood flow
Treatment goals: re-perfusion
STEMI – ST elevation MI
Tests:
- Positive cardiac biomarkers
- Negative ECG
N-STEMI – non-ST elevation MI o Tests:
- Positive cardiac biomarkers
- Positive ECG
Nursing Priorities: MI
Nursing priorities:
Re-perfusion:
- PCI (first line intervention), clot busters (thrombolytics)
Pain management:
- O2, morphine, nitroglycerin
Health teaching:
- Medication regime, lifestyle changes
Pharmacological Interventions: MI
(target vasodilation, clot busting, pain, reduce risk of future complications):
ASE (Alteplase, Reteplase, Aminolase)
Class - thrombolytic
Action – dissolve thrombus
Caution – bleeding risk
Nursing considerations – IV admin
- Nitrates
- Morphine
- Calcium channel blockers
- Beta blockers
- Antihyperlipidemics (statins)
- Anti-coagulants
Complications (caused by damage to heart muscle): MI
Dysrhythmias
Pulmonary edema
Future MI
Cardiogenic shock
Heartfailure
Angina & MI Assessment
Family hx
Age (increased w age)
Gender
Genetics
SDOH
Stress, alcohol, smoking, depression
Comorbidities: HTN, dyslipidemia, diabetes, high BMI, CHF
Medications – blood thinners, nitroglycerin
Signs and symptoms: Angina + MI
Anxiety
o Restlessness
o Dizziness
o Chest pain (pressure, squeezing, or other)
o Irregular rhythm
o Bounding pulse
o Pressure in lef arm, jaw, shoulders & back o N/V
o Flush/pale
o Diaphoretic (excessive sweating)
o SOB
o Tachypnea
o Crackles
Labs & investigations: Angina + MI
ECG (12 lead) – diagnostic test
- Positive – N-STEMI MI
- ST depression – indicator of angina
- No change on ECG – indicator of N-STEMI MI
- ST elevation – indicator of STEMI
Cardiac biomarkers:
- Troponin I (normal = less than 0.03 ng/mL)
–Elevated with cardiac muscle damage
–Elevates 3-6 hours post MI
–Peaks 12-16 hours post MI
–Remains high for 5-9 days following MI
Creatinine
Myoglobin
Heart Failure
Diseased myocardium
- Cardiac output is decreased, decreasing tissue perfusion
- Chronic condition
- Results in acute decompensation
- Goal: QOL, stabilization
- Causes dysfunction in:
Systolic (impaired myocardial contraction):
Contractility issues
Results from ventricles lacking strength
Diastolic (impaired ventricular filling):
Compliance/pre-load issue
Results from ventricles lacking elasticity
Stages of Heart Failure
- Stage 1 (asymptomatic)
Lifestyle modification, ACEi or ARB - Stage 2: mild symptoms with ordinary activity
Lifestyle modification, ACEi or ARBs + beta blocker - Stage 3: moderate symptoms w less than ordinary activity
Lifestyle modification + surgical intervention, ACEi or ARBs + beta blocker + diuretic - Stage 4: severe symptoms at rest or w any minimal activity Palliative or heart transplant
Causes of Heart Failure:
- HTN
- MI
- COPD
- Cardiomyopathy
- Valve issues
Risk Factors for Heart Failure:
- Family hx
- Age (increased w age)
- Gender
- Genetics
- SDOH
- Stress
- Alcohol
- Smoking
- Depression
- HTN, dyslipidemia, diabetes, high BMI, MI
Signs and Symptoms of Heart Failure:
Both sides:
Fatigue, organ damage
- Left side CHF – respiratory congestion, blood backs up in lungs: Dyspnea, SOB, Nocturnal dyspnea, Cough, Crackles, Orthopnea, Decreased SpO2, Extra heart beats/sounds, Palpitations, Dysrhythmias, Increased HR, Weak pulses Dizziness, confusion, restlessness, Altered digestion, Oliguria (w FVO), CKD risk, Pale, cool, clammy skin
- Right side CHF – peripheral and visceral, blood backs up into body: o FVO
Peripheral edema
Weight gain
o JVD
o Unstable BP
o RUQ pain
o Jaundice, itching
o Liver dysfunction
o Anorexia/nausea
o Reduced RBC production (splenomegaly)
Heart Failure: Labs & Investigations
B-Type Natriuretic Peptide (BNP)
- Increased value is associated with HF
- Echocardiogram
o Measures ejection fraction
o Normal = 55-65%
o HFpEF (preserved) = 50-54% o HFmEF (mid-range) = 41-49%
o HFrEF (reduced) = under 40%
Pulmonary Edema
Accumulation of fluid in interstitial and alveoli of lungs
- Can be an EMERGENCY SITUATION (unable to breathe/oxygenate body)
o Can also be chronic
Caused by pulmonary congestion (L side HF)
Signs & symptoms: Pulmonary Edema
SOB, tachypneic, noisy congested cough, SpO2, cyanosis, frothy pink sputum
JVD, tachycardia, weak peripheral pulses
o Restlessness, anxiety (early), confusion, stupor (late)
Nursing Management: Pulmonary Edema
Priority – support oxygenation & treat FVO
High Fowler’s
Apply O2
Initiate IV & administer diuretics, morphine
Monitor ECG
Provide reassurance
Cardiogenic Shock
Compromised cardiac function to the point that it cannot maintain CO and adequate
tissue perfusion
Signs and symptoms: Cardiogenic Shock
Increased HR progressing to decreased BP
Increased RR
Decreased urine output
Pallor, cool
Confusion, agitation
Absence of bowel sounds
- Treatment: inotropic medications to improve CO
Venous Disorders
Venous Stasis Ulcers & Cellulitis
Excavation of the skin surface, inflamed and necrotic tissue sloths off (result of inadequate perfusion)
Venous hypertension creates exudate
Nursing management:
- Treat wounds (skin care, nutrition, mobility, infection prevention) - VTE/DVT – may cause pulmonary embolism
Nursing Priorities for Heart Failure:
- Fluid balance
Daily weights, labs (lytes), intake/output measurements - Mobility
Skin integrity, peripheral venous return - Health teaching
Lifestyle, medication, complication monitoring
Pharmacological Intervention: Heart Failure
(target reduced cardiac workload, reduce symptoms, support cardiac function)
- Antihypertensives: ACE inhibitors or ARBs
- Beta blockers
- Diuretics
- Digoxin
Health Teaching: Heart Failure
- Set goals – requires self-management and monitoring
- Monitor – weight, edema, respiratory symptoms
- Lifestyle – restrict Na (fluids in end stage), engage in exercise, avoid tobacco & alcohol
- Medication education – NO OTC NSAIDS
Surgical Treatment of Heart Failure
- Ventricular Assist Devices
Implantable device that supports heart in maintaining flow, requires lifelong anticoagulant - Heart transplant
Lifelong rejection meds, lifestyle modifications, consider comorbidities
