Inflammation of the sac surrounding the heart. Worse when breathing deeply or lying down (better when sitting up or leaning forward). Chest pain may radiate to shoulders.

Prescribed NSAIDs with possible steroids if pain is not relieved within 48-96 hrs. Use of antibiotics are necessary if infection is present.

complication of pericarditis when the space between the parietal and visceral layers fills with fluid. 

Diagnosed by X-ray, echo

Excessive fluid in the pericardial cavity. It restricts diastolic ventricular filling because the heart cannot expand, as a result, cardiac output drops. 

Diagnosed by ECG or X-ray. If not detected and it is a emergency, patient goes to cath. lab and the fluid needs to be removed (pericardiocentesis).

blockage of an artery in the lungs by fat,
air, a blood clot, or tumor cells.

Activity: bed rest, O2, modify living arrangements and ADL's

Medication: Anticoagulant therapy (heparin, warfarin), some fibrinolytic drugs (breaks down a fibrin clot- protein that is involved in the clotting of the blood).

A collapsed lung is the collection of air in the
space around the lungs. This buildup of air puts pressure on the lung, so it cannot expand as much as it normally.

S/S: sudden, sharp pain on affected side (worse with breathing/coughing), dyspnea (shortness of breath), asymmetric chest wall movement.

Chest pain. 

Nursing Considerations: Stay with patient and assess while questioning. Assess pain (gradual/sudden, local/radiate, sharp/dull).

Chest pain or discomfort that occurs at rest or with exertion and causes severe activity limitation. A increase in the number of attacks and intensity of the pain is what determines it unstable.

3 kinds: new-onset, varient (coronary artery spasm is a temporary, sudden narrowing of one of the coronary arteries), and pre-infarction.

Coronary artery occlusion with death of the tissue. Occurs when the tissue is abruptly and severely deprived of O2. When blood flow decreases 80-90%, ischemia develops (lack of blood supply). Necrosis (tissue death) of myocardial tissue can occur if blood flow is not restored. 

Causes: -Atherosclerosis (plaque build up)

-Rupture of plaque

-Subsequent thrombosis (blood clot)

-Occlusion of blood flow

Lack of O2 without obvious pain but possible signs of decreased O2 sat, diaphoresis (excessive sweating), fatigue. 

Seen more in women, those with diabetes and those who cannot speak. 

1. Assess (ABC's)

2. Reposition (Clear airway- tongue)

3. Administer (mouth-to-mouth)

*No pulse? CPR (30 compressions, 2 vents)

*No Response? AED (Automated external defibrillator)

ABC's (+D)

1. A (Airway)

2. B (Breathing- administer mouth-to-mouth)

3. C (Circulation- CPR if needed)

4. D (Defibrillation- with AED or trained personnel)

-Frequent Vitals

-ECG monotoring

-IV NS

-Obtain Labs (troponin, CK-MB, electrolytes)

-Possible Anti-coagulator Med

-Chest X-ray

-Assessment/History

Prevention and treatment of MI and angina

SE: decreased BP, dizziness, anxiety, headache, tachycardia, CHF, chest pain, cyanide toxicity

Pain management for those with MI.

SE: Respiratory depression

Treats acute coronary syndrome and to prevent ischemic episodes in patients undergoing coronary interventions.

SE: bleeding, headache, dizziness, and weakness

Therapy for acute MI (dissolves thrombi in the coronary arteries).

SE: Chest pain for greater than 30min., ECG will show transmural ischema and injury, bleeding

Contraindications: recent abd surg or stroke, prior intracranial hemorrhage

MONA

M: Morphine

O:Oxygen

N: Nitroprusside (vasodilator)

A: Aspirin

-restoration of blood flow to the heart

2 options

1. Fibrinolytics

2. Percutaneous Coronary Intervention (PCI)

e.g. -Angioplasty (widening a narrow/obstructed blood vessel)

-Angioplasty w/stent

-Atherectomy (procedure for opening a coronary artery blocked by plaque, the buildup of cholesterol and other fatty substances in the inner lining of the artery.)

-indicates a injury (reversible if dealt with quickly), can progress to cell death

- possible beginning signs of MI.

-Reperfusion: damage to tissue when blood returns after a time if ischemia.

Interventions: Nitro (cath. lab), heparin, platelet inhibitor, treat unstable rhythms or BP's

How can you tell someone has had a MI?

(check 3x a few hrs apart to look for a trend. We want to see markers go DOWN not up.)

-ST elevation

-T-wave inversion (reversed position)

-Possible new Q-wave

Cardiac Markers: elevated troponin levels, positive CK-MB (creatine kinase- muscle and brain)= heart muscle damage has occurred. 

-decreased systolic BP>20mm/hg

-HR changes 20bpm

-chest pain/dyspnea

-Cardiac rehab

-1 Nitro for pain (if not relieved call 911)

-wt. gain of >2lbs/day (call MD)

-Low Na+ and cholesterol diet

-exercise gradually

Aspirin

(Effect after MI and SE)

After MI: antiplatelet that prevents clots

SE: GI upset if not taken with food, tinnitus (ringing in ears)

SNS blockers: beta-blocker

(Effect after MI and SE)

After MI: reduce HR, decrease force of cardiac contraction, decrease cardiac workload and the demand for O2

SE: Increases exercise tolerance, hold if low BP(systolic<60)/HR(<60), heart failure, CHF, arrhythmias, reduces CO

ACE-inhibitors

(Effect after MI and SE)

After MI: prevent ventricular remodeling, and the development of heart failure.

SE: rash, tachycardia, cough that may go away in 2 weeks, hypotension if dehydrated

-hold for low BP

-Hyperkalemia? Pregnant? dont give!

-Monitor electrolytes and I/O (contraindicated in renal failure)

Angiotensin II receptor blockers (ARB)

(Effect after MI and SE)

After MI: prevent ventricular remodeling and the development of heart failure (same as ACE-inhibitors)

SE: decrease BP, headache, dizziness, N/V, diarrhea, abd pain, cough, rash, dry skin, cancer development

Lipid-lowering drugs

(Effect after MI and SE)

After MI: reduces the incidence of CAD and MI due to reduction of cholesterol in serum

SE: none noted

Platelet Inhibitor (Plavix- if client received stent)

(Effect after MI and SE)

After MI: prevent re-infarction after MI

SE: bleeding, increased bruising, headache, dizziness, weakness

-Stopped 7 days before any procedures

Coronary Artery Bypass

(vessels used)

-internal mammary (IMA)

-saphenous vein

-radial

prevent excessive blood from accumulating in the pericardial sac or pleural cavity

-If drainage >200cc/hr in the first 4-6hrs, report.

-Protamine

-Vit K

-fresh frozen plasma

-PRBC's (packed RBC's)

plaque within the arterial wall

(leading risk factor of CVD and PVD)

monitor growth, maintain normal BP, yearly ultrasounds or CT scans

antihypertensive medication

Leg pain

-relieved by resting and lowering the effected leg

Peripheral arterial revascularization

(Nursing priorities for the patient)

How is DVT diagnosed?

(Deep Vein Thrombosis)

compression stockings, leg exercises, bed rest 

-No massaging!

given after and major surgery to prevent DVT

can be given at home

Lab test measured to monitor someone on warfarin for a DVT or PE...

(normal range?)

-Avoid injury

-Discontinue before dental visits and surgeries

-Bruising may occure

-monitor intake of vit K

"HIT"

(and its treatment)

Heparin that causes a sudden drop in platelets 

Treatment: Stop all heparin infusions and administer a thrombin inhibitor (argatroban or lepirudin)

stasis ulcer is an ulcer (a crater) that develops in an area in which the circulation is sluggish and the venous return (the return of venous blood toward the heart) is poor. A common location for stasis ulcers is on the ankle.

Stasis refers to a stoppage or slowdown in the flow of blood (or other body fluid such as lymph).

Treatment: Viscopaste dressings, hydrocolloid dressing, unna boot, and avoid tight pants and narrow banded knee socks

Diagnosed: echocardiogram, throat culture

Treatment: bed rest, anti-inflammatories

-Balloon valvuloplasty (open a narrow heart valve)

-direct/open commissurotomy (surgical incision of a commissure in the body, as one made in the heart to relieve constriction of the mitral valve)

-Mitral valve reconstruction

-prosthetic/biologic valves

Dilated cardiomyopathy

(risk factors)

Heart becomes weakened, enlarged, and cannot pump blood efficiently.

Risk factors: Cardiac patients undergoing chemo, viral infections, abuse of alcohol

L side HF occurs first, then R

Left sided: blood backs up into pulmonary

Right sided: blood backs up into the periphery

Heart Failure

(Causes and diagnostic tests)

Causes: HTN, LV damage, aortic or mitral valve stinosis

Tests: X-ray, Echo, check liver enzymes (abnormal in RHF), elevated BUN/creatinine

Class I: no limitations

Class II: slight limitation but comfortable, physical activity results in fatigue

Class III: Limitation on activity, sm physical activity causes fatigue

Class IV: All physical activity is with discomfort. symptoms may be present at rest

defibrillator that shocks the ventricles at the same time so they synchronize 

Used for patients in Class II and have a wide QRS (meaning the ventricles do not contract at the same time)

Increases strength of heart contraction, HR control

SE: Bradycardia, AV block, toxicity

Anyone with DT1

Usually triggered by...

1. A illness

2. problem w/insulin therapy

Patients with DT2

Possible onset causes...

1. illness (that produces dehydration)

2. infection

3. Stress Responcec to a illness