class of antidysrhythmic drug, rarely used, interferes with Na+ channel

Class IA

class of antidysrhythmic drug, Na+ channel blockers,

i.e., Lidocaine

(remember to monitor for Lidocaine toxicity: nervousness, confusion, dizziness, and tinnitus)

Class 1B

Class of antidysrhythmic drugs, most potent Na+ channel blockers, i.e. Flecanide, Propafenone

Class 1C

Class of antidysrhythmic drugs: Betablockers

Class II

Class of antidysrhythmic drugs, K+ influx affected, 

i.e., Sotolol, amiodarone, bretylium

Sotolol - only used if pt unresponsive to other drugs

Bretylium is used for V fib

Class III

class of antidysrhythmic drugs, Calcium Channel blockers,

i.e. Diltiazim, Nifedapine

*No Grapefruit Juice

Remember: grapefruit juice and milk is disGUSTing! :)

Class IV

Class of antidysrhthmic drugs that includes:

adenosine (vasodilator, IV admin only)

atropine (anticholinergic, tx for bradycardia)

digoxin (cardiac glycoside)

Class V

Contraindications:

• acute MI (w/in 2 days)
• unstable angina
• cardiac arrythmias, hemodynamically compromised
• HF, symptomatic aortic stenosis, PE, PI, myocarditis, pericarditis

NSG resp. r/t cardiac stress test:

Monitor/assess:

LS, Resp. status (crackles? wheezing? frothy sputum?)

Heart sounds (may hear S3)

Poor organ perfusion:

*neuro status, UO (<30 cc/hr?)

*decreased periperal pulses, cool/clammy extremities, *fatigue/exercise intolerance, recurrent chest pain, O2 sats

PND = Paroxysmal nocturnal dyspnea (wake up gasping/coughing/wheezing)

Daily wts.

JVD? edema? liver for hepatomegaly?

Collab/DX:

chest x ray, ECG, echocardiography, radionuclide, PT, serum bili, troponin, ABGs, serum elec., cardiac cath.

Assessments for HF

• plan regular exercise
• increase exercise gradually
• avoid overexertion
• space exercise w/rest periods
• keep follow-up appts
• discuss when to call MD if symptoms return

activity with angina pectoris

*avoid excessive activity in cold

*avoid overeating

*sleep in a warm room

*minimize stress/engage in stress reduction activities

MEDS:

*Nitro: carry it with you

keep in container w/tight cover

keep med in cool/dry place

inspect med for exp date (keep up to date)

Angina teaching

*monitor pulse

*take betablockers w/food

*do not suddenly discontinue

*take Ca+ channel blockers 1 hour before or 2 hrs. after eating

*do not omit taking these meds

*do not drive if dizzy or faint

Beta blockers & Ca+ channel blockers

(teaching)

rest

*Na & H2O restriction, O2 (usually nasal cann @ 2-6 L)

Diuretics: Lasix, Bumex, Aldactone

Ace Inhibitors: indicated for most pts w/HF

Vasotec (enalapril)

Capoten (captopril)

Prinivil, zestril (lisinopril)

accupril (quinapril)

**Relax blood vessels so less resistance for heart to pump against

TX for HF

cardiac glycoside = digitalis (digoxin)

*positive inotropic effect (increased contractility)

*negative chronotropic effect (decreased HF)

-results in decreased pulmonary & systemic venous congestion

-monitor lab values (exp. k+)

Hypokalemia may contribute to dig toxicity

(alert: clients on diuretics = K+ loss!)

-Monitor dig levels & for dig toxicity

TX for HF 

Nesiritide: recombination of human BNP

relaxed smooth muscle

reduces aldosterone

for acute HF (dyspnea at rest), IV admin.

TX for HF

-brain natriuretic peptide

-high neg. predictive value

*if normal (<100), able to rule out HF in 98% of cases 

*used in conjunction w/symptoms to diagnose

BNP assay

ephedrine

norepinephrine

examples of vasopressors

*confusion

*palpitations

*angina

*fatigue

*decreased urinary output

increased afterload (increased cardiac workload), greatly decreased stroke volume, and decreased tissue perfusion manifest as...

urinary output is a sensitive indicator of CO

when CO decreases, urinary output decreases

distended jugular veins,

hepatomegaly edema

How does peripheral edema manifest?

cough, dyspnea, frothy sputum

How does increased pulmonary congestion manifest?

Diastolic HF

(less common: about 40% of people)

• ventricular filling and relaxation druing diastole is impaired
• occurs when heart's ability to relax decreases (such as w/htn)
• require higher volume of blood in ventricle to maintain CO
• causes pulmonary congestion & peripheral edema

1. Avoid large meals.
2. Avoid ingestion of myocardial stimulants.
3. Avoid swallowing exceptionally cold or hot food/drink.
4. Avoid a constipating diet.
5. Limit food known to commonly produce excessive gas during digestion.
6. follow a diet plan prescribed for individual needs (wt. loss, K+, low Na+, low cholesterol, etc.)

MI:

Dietary principles during the acute phase of an MI:

• thrombolytics
• morphine sulfate
• nitroglycerin
• lidocaine
• heparin and/or other anticoagulants (ASA)
• diazepan (Valium): help pt relax
• betablockers

Pharm. therapy for MI:

*assess Bp & HR

*don't give to asthmatics (some also contrict smooth muscle of the bronchioles)

*don't give to diabetics (blocks sympathetic responses seen in hypoglycemia)

NSG: assessment for pt rec'g. betablockers

Initially, eat diet that is easily digested. 

5-6 small meals/day, rather than 3 big ones.

calorie controlled, low fat diet.

low sodium

What are the goals of diet therapy for a pt with an MI?

rest & activity:

divide tasks to minimize resp. difficulty/fatigue

oxygenation:

O2 & O2 monitoring, positioning, ABGs

Fluid & Nutrition:

Daily wts, I&O (may have foley in hosp), may be on fluid restriction, monitor LS, assess for pedal edema,

monitor electrolyte levels (esp. if on diuretics),

Na restricted diet (if fluid retention a prob)

avoid excessive fluid intake (above 2L/day)

TX for HF: in addition to pharm:

GI effects: anorexia, N&V, abd pain, diarrhea

Neuro effects: H/A, double vision, blurred/clouded vision (may see a halo around lights), drowsiness, irritability, muscle weakness

Cardiovascular effects:

bradycardia, tachycardia,

bigeminy (PVC), ectopic beats,

pulse deficity

Dig toxicity/effects

Improve exercise tolerance

*rest

*reduce preload (Na+ & H2O restriction, diuretics, vasodilators)

*reduce afterload (Ace Inhibitors, beta blockers, vasodilators)

Improve cardiac contractility: Digitalis (toxicity a concern)

***levels must be drawn on a reg. basis

TX for HF: relieve symptoms

Nursing assessments in HF

*when the heart cannot pump enough blood to meet the body's metabolic needs

*common to all HF pts is chronic progressive changes to the heart in declining pumping ability

NSG: listen to LS, assess LOC, assess for SOB, assess for cough, monitor wt gain (same time/same scale)

Left sided HF

the blood is not moving forward into the aorta and out to my body...IF it does not move forward, then it will go backwards into the lungs...

Left ventricle affected & stroke volume reduced

->pulmonary congestion

S&S: 

dyspnea, crackles

orthopnea (SOB when lying flat), PND

cough

Cheyne's Stoke breathing

weakness, fatigue, difficulty concentrating

palpitations, decreased exercise tolerance

symptoms of Left sided HF

(L ventricle and SV reduced -> pulmonary congestion)

Classification:

systolic vs. diastolic

left vs. right

acute vs. chronic

test for HF: BNP

generally higher in healthy women

*anything <100 is normal

*higher the BNP, the more likely

classification and test for HF

Right sided HF

(Cor Por menalle = pure Rt sided HF)

the blood is not moving forward into the lungs...IF it does not move forward, then it will go backwards into the venous system (R ventricle cannot empty);

*blood backs up into systemic circulation = liver congestion, peripheral edema (swelling in ankles) JVD

Systolic heart failure

ejection fraction decreases

(this means that Left ventricle is failing)

systolic HF (more common)

• Left ventricle cannot contract adequately
• preload increases and stroke volume decreases
• pressure builds in pulmonary venous system

S&S:

• fatigue
• difficulty concentrating
• edema, dependent edema
• increased abd. girth
• nocturia
• JVD

S&S of Right sided HF

(causes liver congestion & peripheral edema)