week4 Flashcards
What is heart failure?
Heart failure is a syndrome defined as the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients
What is heart failure categorised by?
Fluid overload and inadequate tissue perfusion
What is right sided (Diastolic) heart failure?
It is when the right ventricle is unable to eject sufficient amounts of blood and blood backs up in the venous system
What is left sided (systolic) heart failure?
When the left ventricle is unable to pump blood effectively to the systemic circulation resulting in pulmonary congestion
What is heart failure most commonly?
Biventricular (both sides)
What are some of the symptoms of heart failure?
Fatigue Weakness Oedema Weight Gain Anorexia Nausea Ascites Cough/Wheeze Orthopnoea Polyuria at night
What is the initial nursing care of a patient with heart failure
Subjective & Objective health history – sleep and activity
Physical Exam – mental status, respiratory assessment, cardiovascular assessment, fluid status
Assess response to medications
Further medical investigations – Chest X-ray, ECG, Bloods
What are the nursing interventions of a patient with heart failure?
Promoting activity tolerance – cardiac rehab program, encourage mobility, spread out activities
Monitoring fluid volume – daily weight, fluid restriction, FBC, low sodium diet
Oxygen therapy
Psychological support – decreasing stress = decreasing heart workload
What is the medical management of heart failure?
Eliminate or reduce contributing factors
Reduce workload of heart by reducing afterload and preload
Prevent exacerbations
What is ACS?
An umbrella term for heart conditions such as MI’s or unstable angina
What is the initial care of a patient with ACS symptoms?
12 lead ECG
Check cardiac troponins
Oxygen therapy is Sats < 93% for normal patient (COPD patients maintain sats at 88-92%)
Aspirin 300mg unless contraindicated
What are some ischaemic cardiovascular causes?
ACS
Stable Angina
Severe aortic stenosis
Tachy-arrhythmia
What are some non-ischaemic cardiovascular causes?
Aortic dissection
PE
Pericarditis/myocarditis
GI causes
What are some non-CV causes?
Musculoskeletal causes Pulmonary Herpes zoster
How is an irregular heart rate calculated using an ECG?
On a 10 second rhythm strip, count the number of QRS complexes and multiply by 6
How many boxes does a normal P-R interval span across?
Less than 5 small squares
What is the normal width for a QRS complex?
2.5 small squares
What are the 4H’s reversible causes of non-shockable rhythms?
Hypoxaemia- low concentration of oxygen in the blood
Hypovolaemia= decreased blood volume
Hyper/hypokalaemia- blood’s potassium levels are too low/high
Hyper/hypothermia- high/ low body temperature
What are the 4T’s reversible causes of non-shockable rhythms?
Tension pneumothorax= is the progressive build-up of air within the pleural space
Tamponade= is when fluid in the pericardium builds up and results in compression of the heart.
Toxins=poisns/drugs)
Thromboembolic=PE is the obstruction of blood flow to one or more arteries of the lung by a thrombus lodged in a pulmonary vessel
What is the blood transfusion procedure?
Collection of equipment
IV access
Pre-transfusion checks Documentation
Monitoring
What are some possible adverse reactions?
Increase in temperature of more than 1.5*c Shivering Flushing Shortness of breath Pain Decrease in BP Rash/urticaria Haemaglobinuria Anaphylaxis Patient feels “odd”
What do you do if a reaction is occurring?
Stop the transfusion and clamp the line Summon DR
Keep the blood and line so it can be sent for testing
Document
Monitor the patient’s condition re-check patient ID with blood pack
What is another name for Glyceryl trinitrate (GTN)?
Anginine
What is GTN?
A vasodilator which causes coronary vasodilation
What are contraindications for GTN?
Cerebral haemorrhage
Head injury
Hypersensitivity
Angina caused by obstructive cardiomyopathy
What are possible reactions to GTN?
Hypotension Headache Sedation Nausea/vomiting Blurred vision Tachycardia
What is aspirin?
A drug which inhibits platelet aggregation
What are contraindications for aspirin?
Hepatic/renal disease
Bleeding disorders
Gastric/peptic ulcers Hypersensitivity
What are possible reactions to aspirin?
GI distress Nausea/vomiting
Occult blood loss
Dizziness
What is the normal doses of GTN?
600-900mcgs as soon after onset of symptoms
Elderly 300mcgs as starting dose
Buccal mucosa under tongue or in cheek
What is the normal does of ASPIRIN?
75-300mg PO OD
