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Cardiovascular System - Cardiac Study Guide
Bachelor of Science in Nursing (BSN)
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Adult 2 Exam 2
CARDIOVASCULAR DISEASE
####### Leading cause of death for males & females, regardless of race
####### -Cardiac cycle: Systole & Diastole
− Systole is Ventricular Contraction
− Diastole is Ventricular Relaxation
####### -CO: How much blood is ejected every minute (CO=SV x HR)
####### -SV: How much blood is pumped w/ each contraction
####### -Preload: How much muscle is stretched after Diastole
####### -Afterload: The resistance the Ventricle is ejecting against
EKG
During procedure, lie still for 5- 10 seconds
Nurses & Respiratory Therapists can do EKGs
Parts of an EKG-
####### o Horizontal Axis: The time that goes by (each box is 0 sec)
####### o Vertical Axis: Amplitude/voltage
####### o P wave: Atrial Depolarization, not atrial contraction bc this is the electrical activity telling the atria to contract
####### o QRS: Ventricular Depolarization/Atrial Repolarization (hidden)
####### o T: Ventricular Repolarization
####### o U Wave: Purkinje Fibers Repolarization (could be pathological)
ATRIAL FIBRILATION
####### -Uncoordinated Atrial Activity
####### -Atriums are just twitching
####### -Not pushing blood into the ventricle like they are supposed to
####### -No Pattern- R to R distance doesn’t match so rhythm is
####### IRREGULAR
####### -You can’t identify the P
####### -Beta Blockers are given to control HR
####### -Anti-Coagulant (Coumadin) bc they are at a high risk for clots
####### ATRIAL FLUTTER
- “Saw Tooth Wave” between R-R
####### -No distinguishable P wave
####### A Fib is faster & more chaotic than A Flutter
####### SINUS RHYTHMS
####### Sinus Rhythm means the SA node is generating your impulse (the pacemaker)
####### ST DEPRESSION: with low K or if they are on Digoxin
####### Reading a Normal EKG
####### -Normal HR is 60-100 (normal sinus rhythm)
####### -Rhythm: R to R distance should match up
####### along strips (regular rhythm)
####### -P should be in front of every QRS
####### -QRS & T should be pointing same direction
####### STEMI : “ST elevation MI”
####### -Probably means they are having a heart attack
####### -Could be from high K levels
Side Effects: BP, Headache
Nitroglycerin
Vasodilator / Preload & Afterload
Types: o Sublingual: every 5 min up to 3x o Patch ▪ Write date/time/initial ▪ Chart which arm or chest ▪ Tell pts they can shower/swim ▪ Put on in am, take off pm (tolerance) ▪ Prevents CP but does not stop an attack
- Before Giving Nitro--- o Assess BP o Ask if they are on Viagara (both vasodilate, so BP will drop quick) Used if they have had Angina in the past
Assessment
- ECG: 12 lead
- Lab: Cardiac Enzyme- 3 sets, every 6 hrs to see trends o Troponin and CK-MB
- Chest X-ray: CP can come from Pulmonary origin so this is to rule out different things o No metal, Check for pregnancy
Heparin
Anticoagulant Prevent DVT or Clots
SUBQ
o Needle: 5/8 & 25-30G Monitor aPTT o Therapeutic is 45- o Normal is 30 Antidote: Protamine Sulfat Watch for bleeding o BP/ H&H/ HR Heparin Induced Thrombocytopenia o Hold Pressure Longer o Avoid IM Injection o Avoid Continuous BP Cuff
Medications for Angina
Enoxaparin (Lovenox)
####### Must give air bubble to pt bc it
####### seals the medication inside
####### tissue
ASA (Aspirin)
Platelet Aggregation
Risk for Clots
- Dose: 81 mg
- Side Effects: o GI Bleeding/GI Upset
- Ask if they have taken Aspirin that day so you don’t give them too much
Oxygen
(considered a medication)
- Give O2 for CP
- 2L Nasal Cannula & then Call Physician
- Oxygen Toxicity– o N/V o Coughing o Nasal Stuffiness o Sub-sternal Pain
####### Ca Channel Blocker
(Amlodipine/Diltiazem/Verapamil)
- BP - check before giving
- Used for Heart Cath pts o at risk for vasospasms & this med helps that
Beta-blocker
(Metoprolol/Carvedilol) HR and BP
- DONT stop abruptly- Rebound HTN
- DM- masks Hypoglycemia symptoms o Monitor BG often
- Don’t use w/ Severe Asthma or COPD o It can cause bronchoconstriction o Wheezing or SOB-- call provider and switch medications
Angina Pectoris
####### -Stable Angina is relieved by Rest or Nitro
####### -Unstable Angina is not relieved by rest or nitro &
####### considered MI w/ STEMI or non-STEMI
####### MIBI
Technetium-99m labeled methoxy- isobutyl-isonitrile Test Perfusion in Heart IV injection of Radioactive Isotope- not a concern bc lose radioactivity after a few hrs
####### -NO caffeine 12hrs before
- Don’t smoke 2 hrs before
####### -No food 2 hrs before
####### -Lie on back w/ arms
####### extended over head
####### -Camera is taking pics
####### -Test will take 2-3 hrs
####### -Fatigue after is normal
Cardiac Stress Testing
Goal is 80-90% of max HR-- Max HR = (220 – Age) Exercise Stress Test: run on treadmill/pedal bicycle or arm crank; test takes 1-3 hrs Pharm Test: Vasodilators (Dabutamine, adenosine) o Side Effects: Flushing/Nausea/HA/Dizziness
-Avoid tobacco, caffeine, and alcohol before Nursing Interventions -Instruct pt to fast 4hr before test -Can take meds w sips of water -Avoid intense exercise 3 hrs before -Signed consent needed -Dr may say not to take meds (beta blockers) -IV Site just in case they have MI during test Symptoms to Report CP, dyspnea, dizziness, leg cramp, fatigue change in EKG, BP or HR change, pallor, sweat -All indicates (+) EKG—STOP THE TEST -Pt needs treatment in cardiac cath Post-Test: avoid hot bath/shower for 1-2 hrs
Nursing Process: Angina
####### Interventions: Place pt in Semi-fowlers,
####### rest; assess O2 & vitals, EKG and labs;
####### teach stress reduction and prevent pain;
####### stop smoking, watch activity level, carry
####### nitro all the time, follow up appts
Planning/Goals: reserve heart muscles & treat signs and symptoms
Diagnosis: Ineffective tissue perfusion r/t decreased coronary blood flow aeb pt reports chest pain; ABCs, deficient
Assessment: COLDSPA – what were they doing, activity level, risk factors, understanding of CP Physical – vitals, heart, lung, abdomen, peripheral vascular (pulses and edema)
####### Signs & Symptoms
- Chest pain is a Heavy Sensation o “Elephant sitting on chest”
- Pain is usually behind Sternum o Can radiate to Neck, Jaw, Shoulder or Right Arm
- May tell you they have Indigestion & Choking Sensation
- DM-- may not feel Chest Pain due to Neuropathy
- Women & Elderly-- may just have SOB & Weakness or Silent
- May occur upon: o Physical Exertion o Eating Heavy Meal o Stress or Cold Environment bc Vasoconstriction
####### Drug Therapy
(MONA – Morphine, Oxygen, Nitro, Aspirin)
-if 3 Nitros don’t work, call Physician & get an order for Morphine IV Push
- Cardiac rehab: try to return to pre-illness lifestyle/work; teaching, counseling, interdisciplinary team
####### Interventions
Help prevent Pulmonary Edema Need IV Line to Push Meds Semi-fowlers/fowlers to get oxygen to heart Oxygen -HF-- Complication Vitals Q4H Active MI- pt needs to be resting until controlled
####### Diagnosis
-ineffective tissue perfusion - anxiety
####### Assessment
Lungs, Heart, Abdomen, IV site, HR & Rhythm, Appearance, Chest pain, EKG, Respirations -Crackles & Edema –notify the physician
Tempernarde- accumulation of fluid in Pericardial Cavity
Myocardial Infarction
####### -Acute Coronary Syndrome, includes Unstable Angina/nonSTEMI/and STEMI
####### -In an MI, areas of the Myocardium are permanently destroyed resulting in death of Myocardium
####### -Profound imbalance between O2 Supply & Demand
####### 1. Assessment
####### 1. Chest Pain – continues w/ Rest & Nitro
####### 2. Dyspnea, Indigestion, Nausea, Anxiety
####### 2. Diagnostic: Cardiac Enzymes & Biomarkers (Troponin, CK-MB)
####### 1. ECG within 10 minutes
- Goals of Med therapy: Prevent tissue death and prevent complications
Aspirin Antiplatelet Agent
####### Nitroglycerin
Vasodilator
####### Beta Blockers
metoprolol & carvedilol
####### Morphine
Analgesic (monitor RR)
####### Anticoagulants
-heparin & enoxaparin (lovenox)
####### ACE Inhibitors
--Lisinopril (Prinivil)-- workload of the heart, Helps mortality rate, Prevents remodeling of the heart muscle Side Effects:
- Dry Cough
- Retention of K+- (monitor for BP)
- Angioedema- (EMERGENCY) (monitor airway & assess swelling)
####### Thrombolytics (TPA)
Must be given within first 6 hrs to work Assess pt before Contraindicated in Pts:
- Major Recent Surgery
- Past Hemorrhagic Stroke
Can also use to de-clot central line
Coronary Artery Bypass Graft
--Find vein in Leg & Graft to Heart so Blood can Flow--
Post Procedure-- -ICU for 1-2 days---then Med Surg -Pt will have a lot of lines Assess: Vitals, Heart/Lung Sound, Heart rhythm LOC, O2 Sat -Assess incision sites: (big incision on chest & small incisions on legs) -Assess Pain and control it Ambulate : pt needs to be move to chair or ambulate 25-100 ft 48 hrs after to prevent DVT & Atelectasis (if sx while moving, need to stop & notify someone)
-Deep breathe, Cough and Turn -Incentive Spirometry – get baseline & use after surgery -Monitor CBC and BMP
Pre procedure: -Provide Instruction -Informed Consent -Discontinue Meds (anticoagulants, digoxin, diuretics)
Invasive Coronary Artery Procedure
--Heart Catheter can be Diagnostic or Interventional--- Gold standard for detecting Stenosis of Coronary Artery Go thru Femoral Artery & thread all the way to Coronary Artery
- Percutaneous Transluminal Coronary Angioplasty
- Coronary Artery Stent: stent can be coated in meds to help dissolve clot. After they’ll be on Aspirin or Plavix (1 month to 1 year)
- Atherectomy: Cutting & Shaving off Plague
Post Procedure--
-Frequent VS every 15min x every 30min x every 1hour x Assess: -site for bleeding -site should be soft (hard & painful = hematoma) -peripheral pulses -remain flat in bed -keep affected leg straight -analgesics for pain
Pre Procedure--
-Assess allergies -Get signed consent -Renal Function bc of Dye -NPO for 8 hours -May sign Emergency CAGB (for if they have MI during Cath Lab & need emergency surgery) -Tell pt it can take 2hrs or more -May have back pain or feel flushed (dye) (give analgesics)
Abdominal Aortic Aneurysm
####### Damaged media layer of the vessel; weakened spot in artery wall; HTN causes bulge in arterial wall
####### − Risk factors
####### o Genetic
####### o Age & Gender (Caucasian elderly men 4x more than women)
####### o Tobacco
####### o HTN (more than half of people with AAA have HTN)
####### o Atherosclerosis (most common cause)
####### − Signs & Symptoms:
####### o Usually None
####### o Can feel their heart beating in their abdomen-- May be able to hear a bruit
####### − Assessment/diagnostic:
####### o Usually picked up with imaging for other things
####### ▪ If small, monitor every 6 months to make sure it’s not growing too much
####### − Medical Management:
####### o Meds: control BP with oral medication
####### o Surgical intervention: if bigger than 2 in or 5 cm, needs surgical intervention (when it reaches 5 cm)
####### ▪ Open Surgical Repair: open incision & sew stent in place; incision in abdomen
####### ▪ Endovascular grafting: like heart cath, go in through groin area and place stent
- Nursing Management:
####### Post-Op:
####### -Get baseline vitals
####### -Vitals Q15min x 4, Q30min x 4 and then every hour
####### -Assess incision site (no bleeding/hematoma)
####### -Ensure adequate nutrition
####### -Assess pain, color and temperature of legs,
####### peripheral pulses, I/O and volume status
####### Pre-Op:
####### -Maintain Systolic BP 100 -120 by giving Anti-hypertensives
####### -Anticipate Rupture
####### -Impending Rupture Signs:
####### Severe Back & Constant Abdominal Pain (big clue)
####### -Drop in BP, decreased HCT
####### -Get baseline vitals & detect peripheral pulses
Diagnostics
BNP
Hormone that regulates Volume & BP Key Diagnostic Indicator in HF
Normal: 0-100pg/mL HF Pts: around 1000 pg/mL
ECG
Ejection Fraction- % of blood being pumped out
Normal: 55-65%
HF Patients: around 10%
Procedure: -Takes about 1 hour -Lie very still on Left side
####### Lifestyle Recommendations
####### Daily Weight
-every day at the same time/same clothes -empty bladder before -keep diary Should be Concerned: -gain 2-3 lbs/ day -5 lbs in a week
####### Fluid Restriction: (1500ml-2L/day)
####### Sodium Restriction: (2-3g/day)
Heart Failure
####### -can result from HTN and CAD
LEFT SIDED HF RIGHT SIDED HF
####### Backs up to the Lungs
####### Backs up to the Rest of Body
(Peripheral & Visceral Organs)
Dyspnea – (sit pt in HIGH Fowlers)
Low O2 sats – (may need O2)
S3 Heart Sound – (bc large volume of fluid entering ventricles)
Altered Mental Status-- (bc less blood flow to brain)
Pulmonary Crackle
Cough, frothy sputum
Altered mental status
Fatigue
JVD
Edema – (weight gain )
Ascites
Hepatomegaly
Anorexia
Nausea
Weakness
Medications for Heart Failure
####### Hydralazine & Isosorbide Dinitrate
####### Vasodilator
####### Diuretics
####### Furosemide
####### Ca Channel Blocker
####### Amlodipine & Diltiazem
####### Beta Blockers
####### Metoprolol
####### ARBs
####### Valsarten
####### ACE Inhibitors
####### Lisinopril
Digoxin
####### Early Signs of Toxicity
GI Manifestations/ HR Abnormalities/Visual Disturbances (diplopia, blurred vision, photophobia, yellow/green halos)
####### Side Effects
-Anorexia, N&V, Diarrhea -Drowsiness, Fatigue, Weakness -Headache -Depression -Bradycardia, Dysrhythmias -Visual Disturbances
####### Nursing Care
-Assess HR & K before (Apical < 60--hold) (- K+ < 3 ---- hold)
- Tell Teleroom you’re pushing Digoxin bc it will HR
####### Therapeutic Range: 0 - 2 Antidote: Digibind
HR -- by Contraction of Myocardium & Work Load
####### (Digoxin Ejection Fraction)
Cardiovascular System - Cardiac Study Guide
Course: Bachelor of Science in Nursing (BSN)
University: University of Perpetual Help System DALTA
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