Obesity

Diet high in sat fats and cholesterol

Smoking

Stress

Limited exercise

Family Hx

Diabetes

HTN

COPD

Inspection

Palpation

Percussion

Symmetry

Visible pulsations

Sternal notch

Xyphoid Process

PMI= 5th ICS L midclavicular line

R & L carotid

Brachial

Radial

Femoral

Popliteal

Dorsalis pedis

Posterior tibial

varicosities

cords (hard, knot like)

spider veins

TE Echo

Transesophageal echo

Swan-Ganz

only in 48h

EPS

Electrophysiology Studies

Maintain oxygenation

Maintain perfusion

Prevent infection

ventilator

2-3 chest tubes between the medial sternum

IVPB antibiotics

Dressing changes

increase activity ASAP

2-12h

2h for femoral

up to 12 for more interventions

ASA

Plavix

both prevents graph/stent from closing

Lipotor, Crestor, Zetia

decrease cholesterol, raise HDL

Lopressor (metoprolol)

decrease HR and BP to decrease heart's work load

Monitor VS, EKG, pain levels

I&O-keep track of dye or pickup on uriniary retention

FF- flush out dye

Bleeding precautions d/t meds

Assess arterial puncture site

Assess peripheral pulses-to puncture site

Be sure pt voids-before leaving

Do not drive for 48 hours

Do not lift more than 10# for 1 wk

Report any swelling or drainage from puncture site

Rest frequently

Bleeding precautions

If puncture site bleeds or develops hard lump, lie down apply pressure and call 911

If experience chest pain, sit down and call 911-stent may be closed up or clot

Gradually increase activity as per MD

Primary

Secondary

Something wrong with the arteries

most common

Na+ secretion

Sympathetic Nervous System

Renin-Angiotensin System

Volume overload

Increase BP

What do high levels of epinephrine cause?

increased HR

increased BP

usually results in high systolic readings

vasoconstriction

increased sympathetic NS response

increased aldosterone

increased anti diuretic Hormone

increased thirst

increased PVR

peripheral vascular resistance

serial BP measurements

systolic above 150

diastolic above 90

pre-hypertensive is now

systolic above 120

diastolic above 80

MAP below 100

decrease preload-venous side of pump

decrease PVR- arterial side of pump

decrease HR-pump

diuretics

 Furosemide, HCTZ, Bumex

all K+ losing diuretics

 Spironoaldactone, Triemterene

K+ sparing diuretics

direct vasodilators

Apresoline

Minoxidil

Nitroprusside

Hyerstat

Propanolol, metoprolol, atenolol-Beta

verapamil, nifedipine, diltiazem-Ca++

Monitor HR and BP

hold for bradycardia 40 and below

causes orthostatic hypotension

Doxazosin (Cardura)

Methyldopa (Aldomet)

Prazosin (Minipress)

cause sever orthostatic change

give at HS if possible

affect male GU system-used in treatment of BPH

continuous BP monitoring

cause hyperkalemia

excellent for CHF as well as HTN

monitor I&O, weight and BP

Medication does not cure underlying disease

continue to take meds even if feeling better

modify diet

increase exercise

decrease or stop smoking

monitor and record BP weekly

report any dizziness, weakness, fainting

spasm of smaller arteries

most common in smokers and butchers

Inflammation of arterial wall

at temple-emergency

treated with steroids

surgical repair-remove diseases portion of artery and replace with graft material

Stent placement

direct vasodilators

anti-lipemic

platelet aggregate inhibitors

quality of peripheral pulses

skin temp and color (lying flat and with legs dependent)

pain characteristics

peripheral circulation is restored

able to ambulate without pain

changeable risk factors addressed

take meds as directed

regular exercise necessary, regular observation of extremity for infection/injury,safety proof home, follow low fat/low cholesterol diet, stop smoking, avoid weight gain

inflammation of vein

trauma, chemical or mechanical

incompetence of vein leaflets

vein cant hold against gravity

enlarged, distended, visible veins,

c/o aching/throbbing feeling in legs

administer anticoagulants to  prevent further clots- heprin or lovenox

support hose, weight loss,

stripping or ligation

V/Q scan-ventilation/perfusion ratio

spiral chest CT

client will not develop any further thrombi

client will verbalize understanding of anticoagulant medication effects, safety issues, and need for regular blood tests

avoid positions or clothing that restrict venous return

rest with feet higher than heart at least 30"/day

if taking anticoagulants, avoid foods high in Vit K(coumadin only)

coronary atherosclerosis

accumulation of plaque causes decreased elasticity of coronary arterial

sudden occlusion of coronary artery

dead tissue

sudden, severe, crushing pain

radiates to arms, jaw, back

some clients have NO pain-silent MI, N/V, diaphoresis, VS changes-HR and BP will increase-if process not interrupted will see signs of shock, testing positive in cardiac enzymes, 12 lead EKG will show area of damage

Isosorbide-Imdur

NTG patch

treat underlying disease

HTN, DM, hyperlipidemia-statins(Zetia),smoking, weight

Death-dysrhythmias

Cardiogenic Shock-pump failure-metabolic acidosis

Acute PE- LV failure

CHF-R side, L side or both

toxicity

vasoconstrictors, vasodilators, diuretics

ventilator, PA cath, arterial line, FC

Intra Aortic Balloon  Pump

Elevate HOB, apply or increase O2 (1L)

VS, decrease IV rate to 20 cc/hr

Furosemide-40mg IV push

Morphine- 2-4 mg IV push

peripheral edema

decreased activity tolerance

chronic pulmonary edema-dry freq cough

DOE

PND-paroxysmal nocturnal dyspnea

presence of  pain or dyspnea

edema-pedal, periorbital, perineal area, ascites

lung sounds, O2 sats, cough

wt, activity intolerance, VS, I&O

Diuretics-furosemide, bumex, zaroxolyn-fluid excretion

Beta-blockers-metoprolol-slow HR/decrease BP

Cardiac Glycosides-digoxin-slows HR/increase contractions

ACE inhibitors-ACE I-interrups angiotension cycle;ACE II- opens artery

Electrolyte supplements-K+

Coronary Vasodilators- NTG patch, Isosorbide(imdur)-prevent chest pain

chest pain

fever

diuretics, anti hypertensives, anti coagulants to treat immediate symptoms

valve replacement

prophylactic PCN for 2-5 yrs and before any invasive procedure

blood cultures and appropriate antibiotic treatment

identify/treat underlying cause

pericariocentesis or surgery to create pericardial window-drains accumulated fluid

appropriate antibiotic if caused by infection

treatment of underlying cause

cardia output restored to functional levels

infection source eliminated

need for antibiotic prophylaxis prior to any surgical/dental procedures

need for long-term PCN

if valve replaced-need for life-long anticoagulant treatment...blood test, safety factors