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CHA-cardiac
complex health alterations
145
Nursing
Undergraduate 3
07/16/2013

Additional Nursing Flashcards

 


 

Cards

Term
Hypertension
Definition

Prehypertension: 120-139/80-89 mmHg

Hypertension stage 1:
systolic 140-159 diastolic 90-99 mmHg

Hypertension stage 2:
systolic > 160 or diastolic >100mmHg


s/s: "silent killer"

none

dizziness, ha, fatigue

flushed, angina, sob

palpitations, nosebleeds

Term
What bodily mechanisms regulate blood pressure?
Definition

arterial baroreceptors

body fluid volume

renin-angiotensin-aldosterone system

 

Pathology: increased CO, increased peripheral resistance

Term
What is primary hypertension?
Definition
HTN with no causes
Term
What is secondary hypertension?
Definition
HTN with a known cause such as disease process or side effect of a medication
Term
hypertension treatment
Definition

Smoking cessation

exercise

weight reduction

relaxation techniques

Sodium restrictions: less than 2.3 g/day

Term
What drugs are used to treat hypertension?
Definition

diuretics

beta-blockers

calcium channel blockers

ACE inhibitors

ARB

central alpha-2 agonist

direct vasodilators

alpha-1 blockers

Term
atherosclerosis
Definition

The formation of plaque within the arterial wall.


Pathology: injury to inner wall of artery

platelet aggregation/lipid accumuclation

fibrous plaque develops/calcifies

narrowing/occlusion of artery

affects small and large arteries


fatty streaks in lining of artery is an early indication of injury

Term
What are the risks for atheroslcerosis?
Definition

hyperlipidemia

obesity

sedentary lifestyle

htn

dm

renal disease

genetics

 smoking

Term
Atherosclerosis: diagnostic risks
Definition
Cholesterol: high
Triglicerides: high
HDLs: low
LDLs: high
Glucose: high
Term
atherosclerosis tx
Definition

low cholesterol diet

smoking cessation

exercise

weight loss

Term
What drugs treat atherosclerosis?
Definition

bile acid-binding resins

hmg-coa reductatse inhibitors (statins)

nicotinic acid

fibric acid derivatives

cholesterol absorption inhibitors

complementary: garlic, omega 3 fatty acides, fiber, soy

Term
Atherosclerosis: s/sx (not related to extremities)
Definition
- chest pain
- dizziness
- diaphoresis
- SOB
- nausia
- weakness
- fatigue
Term
Atherosclerosis: s/sx relating to extremities (8)
Definition
- pallor in nailbeds
- reddish purple color in lower extrem.
- thickened nails
- dry skin
- loss of hair on extrem.
- diminished peripheral pulses
- cooler skin temp in extrem.
- prolonged cap. refill.
Term
peripheral arterial disease
Definition

pathology: atherosclerosis leads to narrowing/occlusion

tissue ischemia/necrosis

Term
What are the risk factors for PAD?
Definition

SMOKING!! DIABETES, HYPERLIPIDEMIA


African American and Hispanic


Chronic Kidney disease, sedentary lifestyle, sress, Hyper-homo-cystein-emia (venous disease), Metabolic Syndrome, Elevated C-reactive protein

Term
What is the PAD progression?
Definition
Intermittent claudication-->Rest Pain-->Ulceration-->Gangrene-->Limb Loss
Term
How is Intermittent Claudication characterized?
Definition
Muscle ache/cramp caused by walking a specific distance which is CONSISTANT day to day--> relieved by rest-->walk-pain-rest-relief over and over again...
Term
What are the sites of Intermittant Claudication?
Definition
Pain is always one joint level below the blockage, if the WHOLE LEG hurts you have multi blockages. Calf (superficial femoral artery), buttock & thigh (aorto-iliac), foot (tibial and peroneal (ankle) arteries)
Term
What are the signs and symptoms of PAD?
Definition
Dry scaly skin, hair loss, unilateral dependent rubor (purplish reddish when leg is hanging), blanching w elevation (takes longer than 40s to return), poor nail growth
Term
What are the defining characteristics of ARTERIAL ULCER?
Definition
Well demarcated, deep and punched out (circular). DIFFICULT TO HEAL, needs sloughing
Term
What are the main PAD diagnostic tests?
Definition
Duplex ultrasound usually first test, ABI
Term
What are the hallmarks of UE arterial disease? how do you check for it?
Definition
Arm fatigue/pain with exertion, difficulty hold/grasp obj, difficulty DRIVING -- take bilateral brachial BP, if there is a discrepancy >20 mmHg, Unilateral coolness/pallor, increased cap refill time you probably have UE Arterial Disease
Term
What are the Treatment goals for PAD?
Definition
Minimize risk of MI and STROKE by quit smoking, HTN management, lower cholesterol <100 LDL or <70 LDL for high risk.
Term
PAD tx
Definition

weight loss

exercise

smoking cessation

positioning of legs: no crossing, dependent or at heart level

promoting vasodilation: provide warmth, avoid caffeine, nicotine, stress, cold

Wear ted hose stockings

Term
What drugs are used to treat PAD?
Definition

antiplatelet aggregators

antihypertensive

lipid lowering agents

Term
What invasive therapies can be done for PAD?
Definition
angioplasty, arthrectomy, revascularization
Term
What are the six P's of Acute Arterial Occlusion?
Definition
Pain, Pallor, Pulseless, Parathesia, Paralysis, Poikilothermia (equal to environmental temp w/ no temp control)
Term
How do you treat arterial occlusion?
Definition
Anticoag (IV Heparin), embolectomy/thrombectomy, thrombolytic agents
Term
Where in the LE are DVT's likely to occur? What special sinuses in the calves help move blood up to the heart when you walk?
Definition
n the illeo-femoral and in the calf, (especially the SOLEAL SINUSES)
Term

What causes DTV?


What is VIRCHOW's triad of RISKS for DVT?

Definition

It is MULTIFACTORIAL however, stasis is the main cause.



Stasis, Hypercoagulability, endothelial injury


Pregnancy, cancer, oral contraceptives, hormone replacement therapy, Protien defficiency (C, S, Antithrombin III), polycythemia

Term
How significant are CALF DVT's?
Definition
Usually superficial and very low risk of PE, usually they move to deep veins w/o treatment and swelling is minimal
Term
What are the signs and symptoms of DVT? What are the S/Sx of Illeo-femoral DVT?
Definition
Edema, pain (dull, tight OR throb), tender to palpation, warmth, palpable cord (superficial system)--TOTAL leg swelling, SEVERE pain, CYANOSIS
Term
What is the Treatment for DVT?
Definition
REVENT thrombus propagation with ANTICOAG therapy (heparin IV/coumadin), reduce PE risk, promote recanalization (reopening of the vein), preserve valve fxn, avoid post thrombotic syndrome.
Term
DVT or Venous thrombosis
Definition

pathology: endothelial injury: trauma/pressure

venous stasis

hypercoagulability

inflammatory process

 

Term
What is thrombophlebitis? how is it different from DVT's?
Definition
Inflammatory condition limited to superficial veins and is NOT a clot, DVT's are lacking an inflammatory component.
Term
If you have brown itchy ankles and GATOR DISTRIBUTION, itching, weeping and scaling what do you have?
Definition
Chronic Venous Insufficiency
Term
What is the treatment for Chronic Venous Insufficiency?
Definition
Elevate leg, TED hose, sleep w FOB elevated, avoid tight garments
Term
How are venous ulcers characterized?
Definition
Lower third of the calf/gaitor area, pre-tibial region, pitting edema and pain alleviated by ELEVATION, GRANULATION TISSUE and WEEPING/exudate
Term
how do you treat a venous ulcer?
Definition
Debridement (surgical or mesh dressings ALGINATES), Calcium Alginate absorbs exudate and stops bleeding
Term
What is CAD?
Definition

atherosclerosis of coronary arteries

 

Ischemia

oxygen deprivation

myocardial injury

temporary/reversible

 

Angina

chest pain/pressure

with exertion or at rest

stable vs unstable

Term
Modifiable Risk Factors for CAD
Definition

Elevated Serum Levels

HTN (3x for men, 2x women)

Tobacco Use (2-6x)

Physical Inactivity (increases 20%)

Obesity

Diabetes (earlier age)

Metabolic Syndrome

Psychological States (stress, etc)

Homocysteine LEVEL

 

Biggest risk reducer: hyperlipidemia, HTN

How: drug therapy, exercise, smoking cessation, weight loss, low cholesterol diet

 

Drug therapy same for hyperlipidemia to reduce risk

Term
Nonmodifiable Risk Factors for CAD
Definition

Age (55% are 65+)

Gender (Higher in men until women reach menopause)

Ethnicity (higher in African Americans)

Family History

Genetic Predisposition

Term
Acute Coronary Syndrome
Definition

When ischemia is prolonged and not immediately reversible this is indicated. Includes Unstable Angina, Non- ST segment- elevation MI (NSTEMI) and ST-segment elevation MI (STEMI).


prolonged chest pain (> 15 min)

not relieved by rest or NTG

Term
Angina
Definition

Reversible myocardial ischemia. AKA chest pain. O2 demand (of heart) > O2 supply. Primary cause is insufficient blood flow d/t narrowing of coronary arteries by artherosclerosis. The artery is usually 75% + stenosedPredictable pattern of onset, duration and intensity. Lasts 3-5 minutes. Manifests as ST segment depression on ECG. 


can be precipitated by physical exertion, exposure to cold, eating a heavy meal, emotion-provoking situation

Term
What are the types of angina?
Definition

Silent Ischemia:
Up to 80% of patients w/ ischemia are asymptomatic. Associated most often w/ HTN and DM. Confirmed only by ECG changes



Nocturnal Angina
Occurs only at night, but not necessarily during sleep.



Angina Decubitus: Chest pain that occurs only while lying down. Not very common. Relieved by sitting or standing.



Printzmetal's (variant) Angina:
Occurs at rest usually in response to spasm of major coronary artery. Seen in patients with history of migraine headaches and Raynaud's phenomenon. Spasm may occur in the absence of CAD. Chest pain and marked, transient ST segment elevation. May occur during REM and may be relieved by moderate exercise

Term
What drugs are used to manage angina and prevent MI?
Definition

nitrates

beta-blockers

calcium channel blockers

antiplatelet aggregation

ranexa (ranolazine)

Term

Percutaneous Transluminal Coronary Angioplasty (PTCA)

stent replacement

Definition

Role of nurses

Monitor for acute closure of the vessels (s/s of MI)

Bleeding from insertion site or thrombus at insertion site

reaction to contrast solution

Monitor for hypokalemia, hypotension, dysrhthmias

Administer antiplatelet meds

Educate regarding discharge info

Term
Cardiac Catherization
Definition

Visualizes coronary arteries, heart chambers, wall motion

visualize great vessels

calculate cardiac output

measures pressures

determine ejection fraction

 

Check for iodine/shellfish allergies

Monitor for postprocedure bleeding and artery occlusion

Term
Echocardiogram
Definition

Visualizes valves, chambers of heart, wall motion

direction of blood flow through the chambers

Term
Coronary Artery Bypass Grafting (CABG)
Definition

Role of Nurse

 

Pre-op teaching

Mechanical ventilation (usually 3-6 hrs)

Chest tubes

Wound care

Epicardial pacemaker

Monitor pulmonary artery pressure and arterial pressure

Monitor and treat for dysrhythmias

Monitor and treat fluid and electrolyte imbalance

Manage hypo/hypertension

Manage hypothermia

Pain management

splint, cough, turn, deep breath

gradual resumption of activity (begins within hours of extubation)

Term
Myocardial Infarction (MI)
Definition

muscle heart tissue death due to lack of oxygen supply

or

MI occurs as a result of sustained ischemia causing irreversible cellular death

 

Total occlusion of coronary artery. Result of sustained ischemia (>20 min) causing irreversible myocardial cell necrosis. Necrosis of entire thickness of myocardium takes 4-6 hrs. 80-90% caused by thrombus. Most involve the left ventricle. Degree of altered function depend on are involved and size of infarct.

Term
Sinus Bradycardia
Definition

inus node fires <60 bpm. Normal in athletes and during sleep.

 

S&S- pale, cool skin, hypotension, weakness, angina, dizziness, confusion, SOB

 

Associated with- hypothermia, increased vagal tone, parasympathomimetic drugs, Hypothyroidism, increased Intracranial pressure, obstructive jaundice & Inferior wall MI

 

Treatment- Atropine (use caution if MI suspected), Pacemaker, O2 therapy as needed

Term
Sinus Tachycardia
Definition

Discharge rate from sinus node is increased as a result of vagal inhibition and is >100 bpm.

 

S&S- Dizziness and hypotension d/t decreased CO, Increased myocardial O2 consumption may lead to Angina.

 

Associations- exercise, pain, hypovolemia, Myocardial Ischemia, HF, fever, blood loss, anemia, caffeine, nicotine and illicit drugs.

 

Treatment: Determined by underlying cause. Beta blockers to reduce HR and myocardial O2 consumption. Antipyretics for fever. Analgesics for pain.

Term
Sinus Arrhythmia
Definition
Irregular rhythm frequently seen in children and adults that is considered normal. HR increases slightly during inspiration and decreases slightly during exhalation.
Term
Atrial Flutter
Definition

Manifests as shark teeth waves on ECG. Common in elderly, and 64% of S/P open heart surgery experience this. Originates from a single ectopic focus. High ventricular rates >100 and loss of Atrial kick.

 

S&S- SOB, palpitations, anxiety, fatigue. Increased risk for stroke and decreased CO can precipitate angina, HF.

 

Associations- CHF, Rheumatic HD, Pulmonary Embolism, mitral valve disorders, CAD, HTN, chronic lung disease, hyperthyroid, Digoxin, Quindine, epinephrine.

 

Treatment: Antidysrhythmics, radiofrequency catheter ablation can be curative.

Term
Atrial Fibrillation
Definition

Total disorganization of atrial electrical activity d/t ectopic foci resulting in loss of effective atrial contraction. Most common dysrhythmia. Prevalence increases w/ age. Manifests as saw tooth on ECG.

 

S&S- Decreased CO d/t ineffective atrial contractions and rapid ventricular response, thrombi may form in atria d/t blood stasis, Embolus may develop and travel to brain causing a stroke.

 

Associations- underlying HD (rheumatic HD, CAD), Cardiomyopathy, HF, pericarditis, thyrotoxicosis, alcohol intoxication, caffeine, electrolyte disturbance, cardiac surgery.

 

Treatment: Digoxin, beta blockers, calcium channel blockers, Coumadin, antidysrhythmics, cardioversion after 4 week coumadin treatment, radiofrequency catheter ablation, maze procedure

Term
Chest Pain (OLD CARTS)
Definition

Onset

Location

Duration

Character

Associated Symptoms

Radiation

Treatment

Severity

Term
S1
Definition
closure of av valves (tricuspid, mitral)
Term
S2
Definition
closure of semilunar valves (pulmonic, aortic)
Term
S3
Definition
Can be normal in children and young adults. Associated w/ rapid ventricular filling or decreased compliance. Low pitched (heard w/ bell). Can be an early sign of heart failure, MI, mitral regurgitations. "Ventricular Gallop."
Term
S4
Definition
Heard just before S1, low pitched so heard w/ bell. "Atrial Gallop." Can be symptoms of CAD, cardiomyopathy, left ventricular hypertrophy or mitral stenosis.
Term
Troponin
Definition
Myocardial muscle protein released into blood after injury. Detected w/in 1 hour, peaks in 12hrs & remains elevated for 1-3 weeks. 2 types: T & I. Diagnostic for MI if elevated.
Term
CK-MB
Definition
Released into the blood when cardiac cells injured. MB specific to myocardial injury. Rise in 4-6 hours, peaks 18-24 hrs & returns to normal in 3 days. >5 = MI
Term
myoglobin
Definition
Protein highly sensitive for Myocardial injury 99-100% early detector, rise in 30-60 min, peaks 4-12 hrs & normal in 24 hrs. Not diagnostic alone for MI.
Term
homocysteine
Definition

Amino acid that's produced by the body as a result of eating red meat

 

ncreased levels indicate risk factor for CAD. 12-15= moderate risk

15+= high risk

Causes damage to endothelium

Term
B-type Natriuretic Peptide (BNP)
Definition

Elevation indicates heart failure. Releases when myocardial fibers are over-stretched.

Normal is below 100, positive up to 3000. Useful to distinguish between cardiac and respiratory symptoms.

Term
NSTEMI
Definition
Non-ST-Segment-elevation MI. Enzymes are increased, but no reflection on ECG. Partial occlusion of Coronary artery.
Term
Pain from MI
Definition

Total occlusion --> anaerobic metabolism and lactic acid accumulation --> severe, immobilizing chest pain not relieved by rest, position change or nitrates

 

Described as heaviness, constriction, tightness, burning, pressure, crushing.

 

Common locations- substernal, retrosternal, epigastric. Pain may radiate or not

Term
Clinical Manifestations of MI
Definition

"Pale, clammy and cool." Initially increase HR and BP then decreased BP (secondary to decreased CO), crackles, JVD, Abnormal heart sounds. Nausea, vomiting, fever.

Women- SOB, fatigue, weakness

Diabetics- SOB

Elderly- SOB, change in mental status

Term
types of MI
Definition

transmural: entire thickness of myocardial wall involved

 

subendocardial: dmage has not penetrated entire thickness of wall

 

ST segment elevation MI: total occlusion of the infarct artery produces ST-segment elevation.  Most will evolve Q waves on the EKG

Non-ST segment elevation MI: thrombus isn't totally occlusive or rich collaterals.  If cardiac serum marker is detected and non Q wave develops, diagnosis of non Q wave MI is made

Term
Complications of MI
Definition

1) dysrhythmia- most common. 80% s/p MI. Most common cause of death in prehospital period. Life-threatening types seen most often w/ anterior MI, HF or shock

2) HF- pumping power of heart had diminished

3) Cardiogenic Shock- Inadequate O2 and nutrients  are supplied to tissues b/c of severe LV failure. Requires aggressive mgmt.

4) Papillary muscle dysfunction- mv regurg. Aggravates already compromised LV

5) Ventricular Aneurysm- infacted wall thins and bulges during contraction

6) Acute Pericarditis- inflammation of pericardium. See card

Term
Sudden Cardiac Death
Definition
Most occur outside of hospital. CAD accounts for 80% of all. Abrupt disruption in cardiac function, resulting in loss of CO and cerebral blood flow. Death usually occurs w/in one hour of onset of acute symptoms (angina, palpitations). Most caused by ventricular dysrhythmias (v. tach.). Occurs less commonly as a result of LV outflow obstruction (aortic stenosis). Diagnostic to rule out or confirm MI.
Term
What does the nurse do when he comes in with chest pain?
Definition

Immediate assessment

Measure VS, O2 stats

Obtain IV access

Obtain 12-lead EKG

Perform brief, targeted H & P including fibrinolytic checklist

Focus on elgibility for reperfusion therapy

Evaluate electrolyte and coagulation studies

Portable chest x-ray

 

Immediate general tx

O2 at 4 L/min

ASA 162-325 mg

Nitroglycerin SL or spray

Morphine IV (if pain not relieved with nitroglycerin)

Beta-blockers

MONAB

Term

How is an ST-elevation MI determined?

 

Definition

Pain assessment

12 lead EKG

Cardiac markers: cpk, isoenzymes, troponin, myoglobin

 

If ST-elevation MI occurred and is candidate, start thrombolytic therapy

Term
Thrombolytic therapy
Definition

Indications:

chest pain > 30 min and < 6-12 hours, unrelieved with nitro

Indications of transmural ischemia and injury (ST elevation) on EKG

 

Absolute CI:

active internal bleeding

recent stroke

recent intracranial or intraspinal surgery

 

Relative warnings:

severe uncontrolled HTN

trauma or surgery in past 10 days

endocarditis or pericarditis

pregnancy

recent GI or GU bleeding

Term

Thrombolytic Therapy

Nursing Responsibilities

Definition

Prophylactic pressure dressings

assess for s/s of bleeding but don't stop for minor surface bleeding

Neuro checks to detect s/s of intracranial bleeding

Test all drainage for blood

reassess for reperfusion: pain relief, ST turns to normal, PVCs,

bradycardia rapid rise in CPK, hypotension

Term
Adjunctive Tx
Definition

ST elevation

Beta blockers IV

Nitro IV

Heparin IV

ACE inhibitors (after six hours or when stable)

*Don't delay reperfusion therapy

 

NST elevation

tx similar

heparin, asa, ticlopidine, clopidogrel

glycoprotein IIb/IIIa receptor if planned catheterization and troponin is elevated

-interferes with thrombus formation

-abiximab, tirofiban, eptifbatide

Nitro IV

Beta blockers

Pts don't receive reperfusion therapy

Term
Tx for NSTEMI
Definition

bed/chair rest with continuous EKG monitoring

supplement O2 for low O2 sat or resp distress

NTG prn-possible IV NTG

oral beta-blocker within 24 hours unless contraindicated

Calcium channel blocker is beta blocker is contraindicated

ACE inhibitor within 24 hours if pulmonary congestion or low EF (less than 40%)

Avoid NSAIDs other than ASA

Term
Percutaneous Coronary Intervention (PCI)
Definition

May be used to open occluded coronary arteries, establish blood flow, and save tissues

 

Not all hospitals offer tx.

Term
Hospital Stay Tx
Definition

Initial bed rest

light diet

stool softeners

continuous EKG monitoring

frequent cardiac and resp monitoring

phase 1 cardiac rehab

Term
Emotion reactions to MI
Definition

denial, anxiety, anger, depression

 

Maximize and enhance social support systems.

Talk with family and pt.

provide info.

open visitation.

promote constructive coping styles.

Term
Cardiac Rehab and Home Care Management
Definition

Phases: phase one: acute illness to discharge from hospital

Phase two: discharge to convalescence at home.

Phage 3: long term conditioning

 

Low cholesterol, low sodium diet.

smoking cessation

exercise program: start slow, talk with md

sexual activity: none for awhile

med education

 

Term
Heart Attack or Chest Pain Process of Care Measures
Definition

Give ASA at arrival and discharge.

ACE inhibitor or ARB for left ventricular systolic dysfunction.

Give smoking cessation advising if smokes.

Give beta blocker at DC.

Give fibrinolytic med within 30 min of arrival

Give PCI within 90 min of arrival.

Term
Heart Failure
Definition
Causes 1/3 of all MI deaths. Usually affects left side of heart due to decreased contractility. Failure of heart muscle to pump sufficient blood to meet metabolic demands of body. Most common reason for hospitalization in 65+. Risk factors include CAD & advancing age. Also HTN, DM, tobacco, obesity, high serum cholesterol & African American descent.
Term
Systolic Heart Failure
Definition
Most common cause. Impaired ejection/ contraction (below 40%). Increased afterload and less blood circulating to tissues.
Term
Diastolic Heart Failure
Definition
Left ventricle isn't able to relax to allow proper filling. What's in the heart isn't enough, so less blood to tissues. Diagnosis based on the presence of pulmonary congestion, pulmonary HTN, ventricular hypertrophy and normal ejection fraction.
Term
Causes of Systolic Heart Failure
Definition
MI, HTN, Cardiomyopathy, valve disease
Term
Causes of Diastolic Heart Failure
Definition
Chronic HTN, Aortic stenosis, Hypertrophic cardiomyopathy. Isolated right ventricular diastolic failure from pulmonary HTN
Term
Renin-Angiotensis System Activation
Definition
Low blood flow to kidneys --> renin releases which stimulates agiotenisin I & II (vasoconstrictors). Vasoconstriction occurs and angitotensin II stimulates aldosteron which causes sodium and water retention (water follows sodium). ADH is stimulated.
Term
Right-Sided Failure
Definition
Right ventricle cannot eject sufficient amounts of blood and backs up into the venous system. This results in peripheral edema, hepatomegaly, ascites, anorexia, nausea, weakness, weight gain, distended jugular veins, dependent edema and swelling in hands and fingers.
Term
Left-Sided Failure
Definition
Left ventricle cannot pump blood effectively to the sytemic circulation. Pulmonary venous pressures increase backing blood up into the lungs and resulting in pulmonary congestion w/ dyspnea, cough, crackles, impaired O2 exchange, diaphoresis, cyanosis, wheezes, restlessness, confusion, orthopnea, tachycardia and paroxysmal nocturnal dyspnea.
Term
Chronic Heart Failure
Definition
Both left-sided and right-sided failure. Most common. Patient manifest symptoms of both left and right-sided failure. Symptoms include fatigue, dyspnea, orthopnea, PND, persistent dry cough unrelieved w/ position change or OTC cough supplements, nocturia, shiny, swollen, hairless lower extremities and confusion.
Term

NYHA Functional Classification of Heart Disease

Class I

Definition
No limitation of physical activity. Ordinary physical activity does not cause fatigue, dyspnea, palpitations or anginal pain
Term

NYHA Functional Classification of Heart Disease

 Class II

Definition
Slight limitation of physical activity. No symptoms at rest. Ordinary physical activity results in fatigue, dyspnea, palpitations or anginal pain
Term

NYHA Functional Classification of Heart Disease

Class III

Definition
Marked limitation of physical activity. Usually comfortable at rest. Ordinary physical activity causes fatigue, dyspnea, palpitations or anginal pain.
Term

NYHA Functional Classification of Heart Disease

Class IV

Definition
Inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of angina may be present even at rest. If nay physical activity is undertaken, discomfort is increased.
Term
Quality Indicators for Heart Failure
Definition

1) Written d/c instructions including activity level, diet, meds, follow-up appt, daily weights and symptom mgmt

2) Left ventricular function must be documented in record to indicate it has been (or will be) assessed

3) Ace Inhibitor or Angiotensin II receptor blockers for patients w/ known systolic dysfunction (ef <40%) rx at discharge.

4) Current smokers or smokers who quit w/in last 12 mos will be given cessation advice or counseling while in hospital

Term
Diuretics
Definition
Relieve body of excess fluid which decreases preload and work of the heart. Includes thiazides, loops (including Lasix) which are not K+ sparing, and Spironolactone, which is K+ sparing.
Term
Vasodilators
Definition

Increase venous capacity, inprove EF through improved ventricular contraction, slow the process of ventricular dysfunction, decrease heart size, avoid stimulation of the neurohormonal responses initiated by compensatory mechanisms of HF and enhance neurohormonal blockade.

 

Proven to increase survival in HF. Includes:

Ace Inhibitors- "Gold standard" for HF. Also loosens the valve and decreases preload, reduce afterload

 

Angiotensin II receptor blockers

Nitrates- dilation, optimize preload

 

B-Adrenergic (Beta) Blockers- Block SNS response. Decreases BP, HR & contractility, so not ideal. Lopressor and Coreg do not decrease contractility.

Nesiritide, decrease sympathetic stimulation


Digoxin- Improves contractility, increases CO, improve contractility

 

Nitrates: optimize preload

 

morphine sulfate: decreases preload and workload, decrease anxiety, promotes venous pooling

 

Positive inotropic agents for acute heart failure

dobutamine, milrinone, amirnone, dopamine (vasodilators)

 

nesiritide

anticoagulants

hydralazine

Term
Managing Polypharmacology
Definition

Teach purpose and dosage.

Adjustments: time of day if dizziness is a problem

time of day for nocturia

dosage adjustment for weight gain

Teach side effects

Look for barriers to med adherence

Create med schedule with client

Term
Chronic Management
Definition

Education: s/s and when to call the MD

Daily weights: first thing in the AM

Low sodium diet

exercise program: start slow and increase gradually. stop immediately if dyspnea, chest pain, and fatigue occur

 

Enjoy sex when rested.

Don't have sex if irritated.

Wait one to two hours after a meadl.

Don't have sex if drinking.

If sob or chest discomfort, stop.

Term
Pediatric considerations
Definition

Fatigue limits ability to practice developmental skills:

introduce age appropriate toys

create restful home envior.

plan for short play periods after rest.

plan for interactions with healthy children.

 

Promote growth through nutrition:

frequent small feedings.

feedings should be no more than 30 min

Burp after every half ounce.

Term
Nursing Interventions for Acute Phase of HF
Definition

Monitor vitals, cognitive status, skin color

ECG

High fowlers/ sitting position

Auscultate heart & lungs

O2, sats

I/O

Meds as ordered (usually IV Lasix, morphine to relax vasculature)

Monitor electrolytes

Provide calm, reassuring environment

CXR

Assess BNP level

Term
Pulmonary Edema
Definition
Acute event in which the LV cannot handle an overload of blood volume. Pressure increases in the pulmonary vasculature, causing fluid to move out of the pulmonary capillaries and into the interstitial space of the lungs and alveoli. Results in hypoxemia. Symptoms include anxiety, dyspnea, cool/clammy skin, cyanosis, weak but rapid pulse, cough w/ pink frothy sputum, orthopnea, crackles, wheeze and decreased LOC.
Term
Nursing Interventions for Pulmonary Edema
Definition

High fowlers

O2 mask, biPap

BP, HR, RR, UO q1hour

Continuous ECG, pulse ox

Hemodynamic monitoring

Drugs as prescribed

Daily weights

Vent, cardioversion, VAD

Term
Infective Endocarditis
Definition

Microbes colonize and attach to valves (usually prosthetic heart valves or in those w/ structural cardiac defects). Colonies break off and enter peripheral blood stream. Also occurs in IV drug users and in those w/ debilitating disease, indwelling catheters or prolonged IV therapy. Acute (onset w/in 2 weeks of infection) that is more virulent, or subacute (onset weeks-months) which is more common. Acute generally caused by Staph aureus, Strep viridians, virus or fungi while subacute caused by entercocci.

Treatment involves long term IV therapy via picc line for 6 weeks & prophalxis before different kinds of procedures.

Term
Ineffective endocarditis
Definition

fever (in 90%), chills, weakness, splinter hemorrhages in nail beds, petechiae, osler's nodes on fingers of toes, Janeway's lesions on palms or soles, Roth's spots, new onset murmur (d/t clumps on valves), HF in up to 80% w/ aortic valve type.

Arthralgia, myalgia, back pain, abd discomfort, wt loss, HA and clubbing of fingers (only w/ SA type).

Term
Diagnosing Endocarditis
Definition

Recent dental, urologic, surgical or gynecological procedures; heart disease; recent cardiac cath; skin, respiratory or urinary tract infection, IV drug use.

Labs- (2) blood cultures (+bacteria in 90%)

WBC w/ differential

Echocardiogram

CXR

Term
Rheumatic Heart Disease
Definition

Occurs most often in school age children, after undiagnosed strept throat infection. Injury to heart tissue is caused by inflammatory or sensitivity response to streptococci. Myocardial and pericardial tissue is also affected, but endocarditis results in permanent changes to valves. Treatment includes antimicrobials, salicylates, NSAIDS, corticosteroids and prophylactic antibiotics.


all layers of heart may be involved:

Aschoff's bodies: small nodules of collagen fibers

lesions on the valves

cellular infiltrate

Term
Mitral Valve Prolapse
Definition

The stretching of an atrioventricular valve leaflet into the atrium during systole. Most patients asymptomatic for life. Murmur from insufficiency that gets more intense through systole. Clicks mid to late systole that may be constant or vary beat to beat. Can lead to dysrhythmia, paroxysmal supraventricular tach, v tach w/ palpitations & dizziness, and chest pain that occurs w/ stress that doesn't respond to antianginal drugs



Term
Mitral Valve Regurgitation
Definition

Valve doesn't close properly and blood backflows through the valve. Asymptomatic for years until devt of some degree of LV failure. During acute episode there is thready peripheral pulses and cool, clammy extremities, weakness, fatigue, palpitations, dyspnea, orthopnea and edema. S3 or murmur is most likely.


Based on backflow of blood over filling chamber before the valve

s/s: dilation and hypertrophy of both chambers, murmur, fatigue, weakness, dysnea on exertion, orthopnea, palpitations, neck vein distension


Dx: echocardiogram, x-ray, ekg, cardiac catheterization (only if surgery is required)

Term
Pericarditis
Definition

Inflammation of the pericardium (sac that encloses the heart)

acute

chronic constrictive: chronic fibrosis thickening, TB, cardiac surgery, radiation

bacterial, viral, or fungal

Term
Pericarditis S/S
Definition

grating and oppressive chest pain: aggrevated with breathing, coughing, swallowing and supine position

 

pericardial friction rub

elevated wbc and esr

 

ST-T wave elevation in all leads (pericardial inflammation over entire surface of the heart; monitor with series of EKG)

 

fever

 

chronic constrictive-right sided heart failure

Term
Pericarditis Tx
Definition

NSAIDs (escept avoid with acute MI pericarditis)

Corticosteroid therapy (if not bacterial or an acute MI pericarditis)

Antibiotics for acute bacterial

pericardiocentesis if cardiac tamponade

Term
Complications of Pericarditis
Definition

S/S of cardiac tamponade

muffled heart sounds

decreased cardiac output

jugular venous distention

paradoxical pulse (SPB 10 mm HG or more higher on expiration than inspiration)

circulatory collapse: falling arterial pressure, rising venous pressure

 

Impact: ventricular filling impaired

RX: emergency pericardiocentesis and maintain fluid volume

Term
Myocarditis
Definition

Inflammation of the heart muscle

 

Casued by viruses, bacteria, rickettsiae, fungi, parasites, radiation, drug hypersensitivity

 

S/S: fever, fatigue, general malaise, dyspnea, palpitations, arthralgias, enlarged lymp nodes, S3, crackles, JVD

Term
Cardiomyopathy
Definition

Disease of the heart muscle affecting structural or function ability

 

Tx pallative not curative

 

Three types: dilated, hypertrophic, restrictive

 

 

Term
Dilated Cardiomyopathy
Definition

Most common type

dilation of ventricles w/out hypertrophic changes (increased size w/out increased # of cells)

inpaired systolic function, atrial enlargement, LV stasis of blood

 

S/S: fatigue, weakness, palpitations, dyspnea, dry cough

 

Moderate to marked cardiomegaly

 

TX: management of heart failure, diuretics (decrease preload), digoxin (tx atrial fib), ace inhibitors (decrease afterload)

 

implantable cardiac defibrillator as needed

 

cardiac transplant

Term
Hpertrophic Cardiomyopathy
Definition

asymmetric ventricular hypertrophy wihtout ventricular dilation: massive ventricular hypertrophy, rapid,forceful contraction, impaired relaxation, obstruction to outflow

 

S/S: exertional dyspnea, fatigue, angina, syncope or dizziness, palpitations

 

mild cardiomegaly

 

TX: beta-blockers

Calcium channel blockers

antidysrhythmic

ICD, dual-chamber pacing

Surgical excision of part of the ventricular septum

avoid strenuous activity and dehydration: should report dizziness, fainting, irregular pulse

digoxin CI in obstructive hypertrophic cardiomyopathy.  Used to tx afib not failure

Term
Restrictive Cardiomyopathy
Definition

heart muscle impairs diastolic filling and stretch

 

S/S: dyspnea, fatigue, palpitations, activity intolerance

 

mild to moderate cardiomegaly

 

TX: convention therapy for HF and arrhythmias, heart transplant, exercise restriction, avoid dehydration

Term
IDC therapy
Definition

Consists of pacing, cardioversion, and defibrillation therapies to treat brady and tachy arrhythmias

 

External programmer is used to monitor and access the device parameters and therapies for each patient

Term

Cardiac transplant

 

Definition

identify elgible candidate

may have ventricular assist device until heart is available

Postop care: balance risk of rejection with risk of infection

Heart is denervated (affects response to position change, stress,exercise, and certain drugs)

Term

Stenosis

(Valvular heart disease)

Definition

usually caused by rheumatic fever

 

also caused by congenital abnormalities

valve thickened, fibrosed, and calcified

opening smaller than normal

 

S/S: based on chamber before the stenosis working harder

hypertrophy of camber before narrowing

murmur

dyspnea on exertion

fatigue

orthopnea

paroxysmal nocturnal dyspnea

hepatomegaly, neck vein distention, and edema

angina-aortic stenosis

syncope-aortic  stenosis

atrial fibrillation

Term
Nonsurgical Managment of Valvular Heart Disease
Definition

prophylactic antibiotic therapy before invasive procedures if high risk

 

Drugs to control HF: diuretics, digoxin, oxygen, calcium channel blockers or ace inhibitors

 

Tx afib: meds or synchronized countershock

 

anticoagulation- avoid clot on valve

 

rest

Term
Surgical Managment
Definition

After LV failure developed but before irreversible dysfunction

 

reparative procedures:

valvuloplasty: repair of the valve

1. balloon valvuloplasty for stenotic valves: invasive, surgical, balloon inflated to enlarge orifice

Direct (open) commissurotomy: during open heart surgery: visualize valve: separates fused leaflets, thrombi, and calcifications can be removed

Closed commissurotomy: no cardiopulmonary bypass, midsternal incision, small hole cut into heart, commisure opened with dilator or finger

Annuloplasty: repair of junction between leaflets and muscle wall

Narrows valve orifice and treats regurgitation

Replacement procedures: synthetic/prosthetic, biologic/tissue

Term

PT teaching for Valve Surgery

 

Definition

Sternal incision care

watch for infection

return to normal activity after 6 weeks

avoid heavy and physical labor with upper extremities for 3-6 mos

avoid dental procedures for six mos

anticoagulation therapy

antibiotic prophylaxis

Term
Aortic Aneurysms
Definition

wall of aorta weakness and dilates

 

caused by congenital weakness, trauma, or disease

 

most aneurysms found in abdomen below level of renal arteries.  May be in thoracic aorta.

 

Thrombi can form and embolize.

Term
Causes of Aneurysms
Definition

trauma (MVA)

infection

athersclerosis/HTN: biggest cause

after peripheral artery bypass graft surgery at site of anastomosis

Term
Thoracic Aorta Aneurysms/Ascending Aorta/Aortic Arch Clinical Manifestations
Definition

often asymptomatic

 

s/s of rupture: pain in back, flank, abdomen, or groin

shock with rupture

Term
Risk of rupture
Definition

If AAA is > 6 cm in diameter, may rupture within one year.

 

If AAA is < 6 cm, risk of rupture very low.

 

Rupture is life threatening.

 

Term
Aortic Aneurysm Collaborative Care
Definition

                  goal- prevent aneurysm from rupturing

                  early detection/treatment imperative

Determine exact size and location: ultrasound, MRI, CT, angiography

Repeat imaging regularly to determine any changes

Control blood pressure (only if small/asymptomatic)

repair aneurysm before it ruptures

Don't palpate the abdomen if an AAA is known to exist

If rupture not prevented, rapid detection of a rupture: rapid onset of severe back pain with radiation to groin, buttocks, or legs

Term
Benefits of Aortic Aneurysm Endovascular graft procedure
Definition

decreased anesthesia and operative time

smaller operative blood loss

decreased morbidity and mortality

more rapid resumption of physical activity

shortened hospital stay

quicker recovery

higher patient satisfaction

reduction in overall costs

Term
Potential Complications of Endovascular Graft Procedure
Definition

aneurysm growth

aneurysm rupture

perigraft leaks

aortic dissection

bleeding

graft dislocation and embolization

graft thrombosis

incisional site hematoma

site infection

Term
Hemodynamic Stability
Top concern
Definition

Monitor VS.

Assess for diminished or absent peripheral pulses.

Monitor LOC.

Compare extremities appearance.

Monitor urine output, BUN, and creatinine.

Monitor pressures in heart chambers and cardiac output.

 

Term
Arterial Line
Definition

Pulsation from artery is carried through the tubing.  The transducer converts the physical pulsation to an electrical signal.  The monitor shows a digital reading

 

Term
Pulmonary Artery Catheters
Definition

Measure right atrial and indirect left atrial and ventricular pressures

 

Left ventricular end-diastolic pressure is determined by pulmonary artery wedge pressure.

 

Low pressures=low volumes

 

Measure cardiac output, hydrostatic pressure.

 

Term
Normal Ranges for PA catheter
Definition

PAP systolic: 15-26

PAP diastolic: 5-15

PAWP: 4-12

balloon inflated in the PA

Balloon occludes forward flow of blood

Static column of blood from the occluded portion of PA, through left atrium and during open mitral valve during systole

reflects LVEDP

Cardiac ouput: 4-8 liters

Cardiac index (CO adjusted for body size): 2.2-4

 

Term
S/S of internal bleeding
Definition

hemorrhagic shock: hypotension, tachycardia, diaphoresis, oliguria, decreased responsiveness, dysrhythmias

 

Flank ecchymosis (Grey Turner's sign)

Abdominal distention

 

Term
Postop Care for AAA
Definition

Arterial line-monitor bp

contiuous cardiac monitoring

hemodynamic monitoring: pulmonary artery catheter

may be on ventilator overnight

hourly pulse and extremity checks

Limited HOB elevation to avoid flexion of graft

hourly urine output

Monitor BUN and creatinine

T,C, and DB

abdominal assess: paralytic ileus

NG tube for 3-4 days

avoid heavy lifting for 6-12 weeks.

Term

Clinical Manifestations of an Aortic Dissection


Most common: ascending aorta and descending thoracic aorta

Definition


s/sx depend on location of intimal tear and extent of dissection

pain characterized as:

sudden, severe pain, in anterior part of chest or intrascapular pain radiating down spine to abdomen or legs

described as tearing or ripping or stabbing

may mimic that of MI

decrease or absence in peripheral pulses

aortic regurgitation with murmur

Term
Cardiac Tamponade as result of Aortic Dissection Complications
Definition

Severe, life threatening complication

occurs when blood escapes from dissection into pericardial sac

Clinical manifestations include:

hypotension

narrowed pulse pressure

distending neck veins

muffled heart sounds

pulsus paradoxus

Term
Aortic Dissection Treatment
Definition

 bed rest

pain control with opioids

control BP

Control HR and myocardial contractility

1. IV beta blocker-esmolol

2. oral beta blocker-propranolol

3. sodium nitroprusside

4. calcium channel blockers

5. ACE inhibitors

Descending dissections may be treated with a stent

success of therapy evaluated by pain relief

surgery: resection of segment of aorta with initial tear.  Indicated if drug therapy is ineffective or when complications occur.  The location of the dissection also influences the need for surgery.

 

Term
Aortic Dissection Discharge Teaching
Definition

Therapeutic Regimen (antihypertensive drugs and side effects)

if pain returns or symptoms progress, instruct patient to seek immediate help

Term
Postop Care for thoracic aortic aneurysm
Definition

Hourly VS

cardiac monitor

monitor chest tube drainage

assess motion and sensation in all extremities (paraplegia from interruption of blood supply to spinal cord)

May be on ventilator overnight

Term
Postop Care for endovascular repair of AAA
Definition

hourly vs

hourly groin checks

peripheral pulse checks every 4 hrs

pain assessment

encourage c and db

dvt prophylaxis

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