26-29 Flashcards
(176 cards)
1
Q
Cardiac Surgical Procedure:
________ mechanically circulating and oxygenating blood outside of the body while the beating heart is stopped.
A
Cardiopulmonary bypass (extracorporeal circulation)
2
Q
Disadvantages of cardiopulmonary bypass (extracorporeal circulation
A
long operative period, anticoagulation, hypotension, risk for stroke, dysrhythmia.
3
Q
Myocardial Revascularization
_______ Indications
-the client has multiple coronary artery occlusions.
-Atheromas are calcified and noncompressible
-anatomic location of the occlusion interferes with the safe insertion of a coronary artery catheter.
A
Coronary artery bypass
4
Q
Myocardial Revascularization
_______ procedure: Bypassing or detouring around the occluded portion of one or more coronary arteries with a relocated blood vessel.
A
Coronary Artery Bypass
5
Q
In coronary artery bypass what Graft vessel is used (vein)
A
Saphenous vein.
6
Q
Coronary artery bypass alternate graft vessel
A
Internal mammary, internal thoracic arteries, basilic, cephalic vein in arm, radial artery, gastroepiploic, artery from stomach.
7
Q
Myocardial Revascularization
Surgical techniques
____________
-No use of cardiopulmonary bypass machine, adenosine (adenocard) used to slow the HR.
-Instruments lift and stabilize graft vessels on anterior, lateral, and posterior wall of the beating heart.
A
Off-pump coronary artery bypass. (OPCAB)
8
Q
Myocardial Revascularization.
Surgical techniques
___________________
Procedure: endoscopic view of heart and grafting vessels through a small incision between the ribs.
Limitations: only one or two vessels grafting.
A
Minimally Invasive Direct Coronary Artery Bypass.
9
Q
Myocardial Revascularizaton:
_______________ also called TECAB
Procedure: uses cardiopulmonary bypass machine attached to femoral artery and vein rather great vessels of heart.
Triple lumen vascular catheter inserted via thoracoscope; video camera and transesophageal echocardiography to visualize operative area.
Advantage: shortened operative period, reduced mortality rate from complications, faster recovery.
A
Port access coronary artery bypass (PACAB)
10
Q
A client recovering from a conventional coronary artery bypass graft (CABG) procedure. The nurse can expect __
A
Assess a 12-inch midchest incision.
Rationale: A CABG includes a 12-inch midchest incision and duration of hospitalization of 7-10 days and 6-10 week recovery time. The minimum number of grafted arteries is 5. The use of cardio pulmonary bypass is used during the CABG
11
Q
________ and ______
Methods of repair:
Commissurotomy: opening adhesions in the valve cusps; thoracotomy
Balloon valvulopasty: balloon catheter to stretch the stenosed valve.
Valvuloplasty: valve repair
Annuloplasty: repair of fibrous ring that encircles the valvue
A
Valve repairs and replacements
12
Q
Opening adhesions in the valve cusps; thoracotomy
A
Commissurotomy
13
Q
Balloon catheter to stretch the stenosed valve.
A
Balloon valvuloplasty
14
Q
valve repair
A
valvuloplasty
15
Q
repair of fibrous ring that encircles the valve
A
Annuloplasty
16
Q
Valve repairs and Replacements
Valve replacement types:
-Mechanical valve
-Bioprosthetic valve
A
Advantages: less surgical trauma, decreased blood, faster mobility, less mechanical ventilation, improved cosmetic appearance.
17
Q
Repair of ventricular aneurysm and heart tumors
Ventricular aneurysm
A
Causes: infarcted area of myocardium balloons outward and form thrombi; myocardial infarction.
-Emergency procedure to suture weakened area.
18
Q
Repair of ventricular aneurysm and heart tumors:
Removal of heart tumors.
A
Benign and malignant tumors-rare
Benign tumors extend from pedicle-uncomplicated; malignant tumors-poor prognosis.
19
Q
Repair of heart trauma
Nonpenetrating injury of the chest-results in cardiac tamponade.
-causes: crushing injury causing bruising and bleeding.
TX: bed rest, pericardiocentesis, open thoracotomy.
A
Penetrating injury:
Causes: stab wound
TX: large tears- surgery, causes immediate shock from hemorrhage.
20
Q
Normal PR interval
A
0.12 to 0.20 seconds = three to five boxes.
21
Q
QRS complex normal value
A
<0.12 sec =3 boxes.
22
Q
QT interval
A
Normal: needs to be corrected for HR- usually 0.44 o 0.32 seconds. (HR of 60 to 100 bpm for both men and women)
23
Q
1 tiny box on the EKG equals
A
.04
24
Q
1 large box (five tiny boxes) on the EKG strip equals
A
.20 sec
25
there are 300 boxes on a 1-min strip of EKG paper
| There are 1500 tiny boxes in a 1-min strip of paper
know
26
Heart Transplantation:
| what are the causes
Cardiomyopathy, end-stage coronary artery disease, end-stage heart failure, congenital cardiac defects.
-National Organ Transplant Act (1984)
27
Transplant problems
- Rejection- hyperacute, acute or chronic rejection; fever (temp > 100 F, flulike sx. SOB, chest pain, weight gain, fatigue, elevated BP
- Immunosuppressive drugs: cyclosporine (sandimmune), azathioprine (Imuran)
28
Transplant prob continued
Infection
Causes: bacterial, viral, and fungal infections due to immunosuppressive drugs; sx similar to rejection.
-Life threatening: treated with antibiotics, antivirals, and antifungals
-high cost- preheat transplant evaluation, surgery, drugs, postsurgery care, and follow up tests-millions of dollars.
29
Heart transplant problems
- cardiovascular disease- CAD common problem among heart transplant recipients; do not experience angina bc of the hearts nerve supply is not intact.
- rate of survival: 85-90% 1 year after surgery, 10 yr survival 56%
- scarcity of donor organs- 20% of 3000 people awaiting heart transplant die before donor becomes available.
30
Central or peripheral vascular surgical procedures
| -__ ___ bypass or replace diseased sections of major systemic blood vessels; aorta, femoral, popliteal artery
Vascular grafts
types:
Synthetic fiber: dacron, Teflon
Human tissue: cadavers
31
Removal of thrombus or embolus occluding a major vessel
Embolectomy and thrombectomy
32
Replacement graft
_____ Procedure: resection and removal of lining of an artery.
It removed atherosclerotic plaques from aorta, carotid, femoral, or popliteal arteries.
Endarterectomy.
33
___ ___ is where the nurse will assess the volume and pressure of blood in heart and vascular system; its a surgically inserted catheter.
Methods: BP monitoring, catheter placement in peripheral artery, radial, brachial, or femoral artery
CVP: right atrial pressure; normal 2-7 mm Hg; jugular or subclavian vein
Pulmonary artery pressure monitoring- assess left ventricular function; pulmonary capillary wedge pressure, left ventricular end diastolic pressure, cardiac index.
hemodynamic monitoring
34
Right atrial pressure, normal 2-7 mm Hg; jugular or subclavian vein is a method called
CVP
35
Assess left ventricular function; pulmonary capillary wedge pressure, left ventricular end-diastolic pressure, cardiac index is a method called
Pulmonary artery pressure monitoring
36
A client recovering from cardiovascular surgery is at risk for decreased cardiac output related to impaired ventricular contraction. to maintain an adequate cardiac output, nursing interventions include what
Administering prescribed inotropic and antidysrhythmic medications
37
BP is a reflection of
cardiac output and peripheral resistance.
38
BP reflects the ability of the arteries to stretch and fill with blood, how efficient our heart is as a pump and volume of circulating blood.
know
39
The ANS, Kidneysm and various endocrine glands regulate BP
know
40
___ ___- force of blood of ejection of L Ventricle- reflects ability of arterial system to distend with ventricular contraction
Systolic BP
41
Pressure in our arteries during ventricular relaxation is called
diastolic BP
42
What makes up the regulation of BP
Baroreceptors
Chemoreceptors
ANS
Renal- By renin- angiotension/aldosterone
43
A sustained systolic BP 140 or greater or a sustained diastolic BP 90 or greater or both is called
Hypertensive disease
44
BP greater than 120/80 is called
prehypertension
45
___ ___ ____- INC BP has caused cardiac abnormality
Hypertensive heart diease
46
Vascular damage without heart involvement is called
hypertensive vascular disease
47
Both the heart and vascular disease is called
hypertensive cardiovascular disease
48
___ ____ is sustained elevated BP without a cause
Essential HTN
49
___ ___ is sustained elevated BP due to another disease
Secondary HTN
50
___ ___ ___ is a BP that elevates in presence of medical personnel
white coat HTN
51
Essential HTN:
Cause: unknown
Risk factors?
Age, obesity, cough potato smoking, ineffective stress management- excessive alcohol.
Race: African Americans
Hypernatremia, hypokalemia, direct in renin-angiotensin-aldosterone system
Def I Natriuretic factor
52
____ ____ accompanies any condition that affects the fluid volume, kidney function, or that causes vasoconstriction of the arteries.
Secondary HTN
53
Predisposing factors of secondary HTN
kidney disease, pheochromocytoma, hyperaldosteronism, atherosclerosis, cocaine, oral contraceptives, cardiac stimulants.
54
Organ damage and complications are the same with either one!
| Heart works harder to pump against increased resistance- heart enlarges-heart failure-angina
know
55
HTN is often the frequent cause of stroke and heart failure
know
56
HTN also speeds up process of atherosclerosis. Brain eyes and kidneys are all affected.
know
57
S/S of HTN
```
(silent killer)
Throbbing/pounding H/A
Fatigue
Nose bleeds
insomnia
blurred vision
angina
dysnpea
```
58
Physical assess reveals a ____ ___ in one or both BP measurements
sustained elevation
- pounding pulse
- flushed face
- peripheral edema
- papilledema/retinal hemorrhages
59
Dx of HTN
BP measurements
| test to assess extent of any organ damage
60
TX of HTN
Primary objective is to decrease BP to prevent complications
61
What # do we start to TX BP
dependent on how many factors such as age, chronic conditions.
older than 50- want to decrease systolic BP to below 140 and DM and chronic renal disease less than 130/80
62
Treating BP
We first want to make diet and lifestyle changes, no smoking, low fat, and low NA diet, decrease alcohol.
63
drug therapy for HTN
HCTZ- usually need two drugs to decrease (thiazide, + ACE) depending on response may use others like
beta blockers, ca channel blockers, ARBS
64
Accelerated and malignant HTN
Terms are used when BP extremely elevated. >160/100
65
BP extremely elevated with hemorrhages in eyes is called
Accelerated
66
Untreated accelerated becomes this-papilledema is called
Malignant
67
You will often see accelerated and malignant when someone is in a hypertensive crisis.
may have abrupt onset and complications can occur rapidly **MUST decrease BP immediately.
68
SS of accelerated and Malignant BP
```
BP greater than 160/100
confusion
severe HA
seizures
C/P
visual disturbances
dyspnea
```
69
TX to accelerated and malignant BP
want to decrease BP in 1-2 hr
PO Nifedipine-verapamil-captopril
IV Diazoxide-Nitroprusside-NTG-Labetalol
70
O2 is given to tx hypoxia- induced tachycardia
know
71
Medication controls HTN but does not cure HTN
know
72
Nursing care for HTN
- monitor BP closely
- IV antihypertensive always ADM per pump
- limit activity
- monitor neuro, renal, cardiac status
73
Medications for HTN:
| All can cause postural hypotension
```
ACE inhibitors (prils)
-may experience sudden drop in BP 1-3 hr after 1st dose- persistent dry cough may be S/E and will need to be DC and changed to different class of anti-hypertensive.
-beta blockers- end in lol
CA channel blockers- Nifedipine/Verapamil-act by vasodilating.
```
74
```
____- graphic recording of electrical currents made by heart muscle.
done on graph paper as waveforms
rhythm strips/ ECG recording
normal sinus rhythm
review conduction system of heart
```
electrocardiography
75
___ ___ ___ means impulse starts in SA node- P wave is upright before each QRS complex and each complex is distinct and regular.
Normal sinus rhythm
76
ST depression means
MI
77
____ upward- SA node firing which cases atrial contraction is called the
P wave
78
___ ___ is the time it takes to travel through SA node pathway by AV node
PR interval
79
___ ___ impulse is traveling through bundle of his, bundle branches and purkinje fibers
ORS complex
80
__ ___ is repolarization of ventricles
T Wave
81
If HR is irregular- determine rate by counting large squares between QRS complex & divide into 300
know
82
ECG interpretation
```
RATE
RHYTHM
P WAVE PRECEDES QRS
PR INTERVAL
QRS WIDTH
```
83
ST depression means
ischemia
84
ST elevation means
muscle damage
85
___ ____ indicates the repolarization of the ventricles
ST segment
86
the heart has a fail safe system
If SA fails, AV takes over, if AV fails ventricles take over,
87
Heart rate is slower and is called ___ ___ during the fail safe system
Ectopic focus meaning something else is initiating it .
88
Irregularity in heart rhythm, its a disorder In the hearts conduction system that causes an abnormally slow/fast HR. Or one that does not proceed through conduction system in a usual manner is called
dysrhythmia/arrhythmia
89
___ ___ is where the HR is less than 60 bpm
goes through conduction pathway normally
normal in athletes, pathologic in hypothyroidism, increased ICP, digitalis toxicity, heart disorders.
Sinus bradycarda
90
TX for sinus brady cardia is
IV atropine sulfate
91
___ ___ rate greater than 100 bpm
It goes normally through conduction pathway, normal in healthy hearts during exercise, emotional stress often cause, anxiety, fear, hemorrhage, shock
sinus tachycardia
92
for sinus tachycardia you TX the cause
know
93
Nerve tissue in the area other than the SA node causes an early impulse/beat-usually see a normal P wave
PAC'S- Premature atrial contraction
94
Causes of PAC'S
caffeine, nicotine, stimulants, heart disease, hyperthyroidism.
95
TX of PAC'S
none unless causes SVT (super ventricular tachycardia)
96
Dangerously fast heartbeat-greater than 150 BPM
SVT (super ventricular tachycardia)
| Cardiac output drops because ventricles do not have time to fill adequately- could lead to HF.
97
TX of SVT (super ventricular tachycardia)
Digitalis/ CA channel and adrenergic blockers to slow HR
98
Impulse outside SA node causes atria to contract at very rapid rate 200-400 BPM. AV node can only conduct some of the impulses to ventricles
*SAWTOOTH flutter on waves of ECG
atrial flutter
99
May precede Atrial fibrillation greater than 400 bpm- atria just quiver and do not contract.
Ventricles can not respond as needed, poor Cardiac output. Blood clots may form in atria.
know
100
TX for atrial fibrillation
Digitalis, Verapamil, Propranolol (beta blocker)
Cardioversion (chemical/elective)- shock,
chemical use, Ibutilide (corvert)-aspirin & warfarin
101
people can survive in chronic atrial fib-require anticoagulant therapy.
know
102
Surgical intervention for A fib
maze or mini maze. procedure can be performed in which a surgeon restores the normal conduction pathway by eliminating rapid firing ectopic pacemaker.
103
abnormal slowing of electrical impulses through AV node
Av Node dysrhythmia.
104
"heart block" 3rd degree means
complete
105
"heart block" 1st and 2nd mean
the impulse is delayed.
106
in complete "heart block"
the impulse does not get through and ventricles develop their own rhythm- 30 bpm
107
TX for complete "heart block"
pacemaker
108
___ early contraction of ventricle before sa node initiates the impulse.
PVC
109
ventricular dysrhythmias are more dangerous than atrial
know
110
in ___ ____ there are no p wave and QRS is wide and odd looking
-may cause flip flop feeling in chest-occasional are harmless.
ventricular dysrhythmias
111
Causes of ventricular dysrhythmias
stress, fatigue, alcohol-withdrawl.
112
Dangers with ventricular dysrhythmias
- 6 or more per min (need a 24 holter monitor)
- 2 in a row
- 3 or more-tigeminy
- bigeminy-every other one
- multifocal
- R on T phenomenon
113
Ventricles are initiating the heart beat-150-200 bpm
- decreased cardiac output- may pass out or be pulseless.
- may stop abruptly or require Defibb
- no p waves
ventricular tachycaria
114
Rapid irregular twitching of the ventricles
| *dying heart rhythm
ventricular fibrillation
115
Most dangerous arrhythmia is
ventricular fibrillation
116
TX for ventricular fibrillation
CPR- immediate Defibb- Epinephrine
117
Ventricular stand still-cardiac arrest-flatline is called
asystole
118
TX of asystole
CPR- Defibb
119
Tx of dysrhythmia
- not all are life threatening
- elective electrical cardioversion-tx for rapid atrial arrhythmias
- similar to defib but does not discharge until appearance of R wave so does not disturb heart during ventricular repolarization. The electrical current depolarizes the myocardium and as heart repolarizes the SA node takes over as a pacemaker.
- defibrillation/AEDS- tx for life threatening ventricular dysrhythmia- if done in first 5 min of V-fib or arrest have 50% survival rate
120
TX for rapid atrial arrhythmias, does not discharge till appearance of R wave, does not disturb heart during ventricular repolarization. The electrical current depolarizes the myocardium and as heart repolarizes the SA node takes over as pacemaker
Elective Electrical Cardioversion
121
TX for life threatening ventricular dysrhythmia- if done in 1st 5 min of V-Fib or arrest have 50% survival rate
Defibrillation/ AEDS
122
___ ___ ___ used for recurrent life threatening tachydysrhythmias. Senses cardiac rhythm and delivers a shock when needed.
Automatic implanted Defib
123
with a automatic implanted defib what should you avoid
avoid strong electrical current in things like ARC welder and strong magnetic fields such as MRI
-you need to carry an ID stating that alert to others.
124
Used to TX brady dysrhythmias
pacemakers
125
types of pacemakers
| -___ self activates when heart rate drops
Demand
126
types of pacemakers
| -___preset rate
Fixed
127
types of pacemakers
- permanent
- temporary
monitor for spikes on rhythm
128
Catheter is inserted VENOUSLY into heart and tissue producing abnormal rhythm is destroyed.
Radio frequency catheter ablation
129
the ___
Cardiac function: the ___ is a double pump; right side pumps deoxygenated blood into the lungs for oxygenation, and the left side pumps oxygen rich blood into the system circulation.
-this process provides a continuous supply of oxygen and nutrients; cellular metabolism and mechanism to eliminate CO2
heart
130
If there is disturbances in one part of the heart, if severe or prolonged, eventually affect the entire circulation
know
131
inability of the heart to pump sufficient blood to meet the bodys metabolic needs
HF
132
estimate of the hearts efficiency
ejection fraction
| Normal: ejects 55% or more of the blood that fills the left ventricle during diastole
133
accumulation of blood and fluid in the organs and tissues from impaired circulation
CHF
134
___ ___ ___ is a sudden change in hearts ability to contract; causes life threatening sx and pulmonary edema.
acute heart failure
135
__ __ __ is hearts ability to pump effectively is gradually compromised; impaired contractility remains prolonged.
chronic heart failure.
136
American Heart Association:
| Four stages: stage __ no current sx but more risk factors (HTN, diabetes)
stage A
137
stage ___ is advanced structural heart disease and marked symptoms at rest despite maximal medical therapy
stage D
138
Heart is a two sided pump so either side can have failure and one can affect the other
Two reasons the heart fails.
- *inability of heart muscle to contract due to direct damage to myocardium
- enlargement of pumping chambers which eventually causes them to weaken.
139
Patho and etiology of HF
inability of heart muscle to contract bc of direct damage to the muscular wall.
140
Causes of left sidedHF
myocardial infarction, cardiomyopathy, and HTN
141
causes of Right sided HF
left sided HF, COPD
142
When the left ventricle fails the heart, muscle cannot contract forcefully enough to expel blood into the systemic circulation.
left sided HF
143
complications of L sided HF
- Pulmonary vascular bed; fluid accumulates and creates congestion
- gas exchange is impaired, cells become hypoxic, CO2 accumulates in blood
- HTN, tachydysrhythmias, valvular disease, cardiomyopathy, renal failure, heart failure
144
where fluid accumulates and creates congestion is called
pulmonary vascular bed
145
HF assessment finding
hypoxemia, unusual fatigue with activity, exertional dyspnea (first sx), orthopnea, paroxysmal nocturnal dyspnea (sleep with several pillows in bed or in a chair), pulse rapid or irregular, BP elevated, cough, hemoptysis, moist crackles, urine output diminished.
146
acute L sided HF
pulmonary edema, hypoxia, restlessness, confusion
147
L sided HF
| Chest radiography
Cardiac enlargement, and fluid accumulation in the lungs
148
L sided HF
| Echocardiogram
size of left ventricle and ineffective pumping of the heart
149
L sided HF
| Multiple gated acquisition (MUGA)
measures a decrease in the ejection fraction
150
L sided HF
| ABG
analysis, serum, sodium, blood urea nitrogen
151
The right ventricle cannot forcefully contract and push the blood through the pulmonary artery is called
right sided heart failure
152
Complications of Right sided HF
- congestion of blood and backflow accumulate first in the right ventricle, then in the right atrium, superior and inferior vena cavae, venous vasculature
- chronic resp disorders: ex- cor pulmonale, condition in which the heart (cor) is affected by secondarily by lung damage (pulmonale)
153
Assessment findings:
| gradual unexplained weight, dependent pitting edema, ascites, hepatomegaly, jugular vein distention
Enlarged abd organs-dyspnea
fluid retention-rings, shoes, or clothing become tight
accumulation of blood in abd organs- anorexia,nausea, and flatulence
*major cause of R sided HF is L sided HF
154
Dx findings for R sided HF
```
chest radiograph
ECG
Echocardiography-ventricular enlargement
lung scan and pulm arteriography:cor-pulmonale
liver enzymes
```
155
_____is a hormone stimulated by released depending on degree heart muscle is stretched.
greater than 400 have increased change of HF
B type natriuretic peptide.
156
HF compensatory mechanisms
- reduced cardiac output-hypotensive; low BP, stimulates the sympathetic nervous system to release catecholamines to raise HR and BP
- increased force and contraction of heart maintains Bp but increases myocardial oxygen demand.
- epinephrine causes blood vessels to constrict; body shunts more blood to vital organs of the brain and heart, decreasing blood supply to kidneys.
- ventricles secrete neurohormone B type Natriuretic peptide BNP
157
Nursing management of HF
- medication: teaching, lifestyle changes, diet restrictions.
- hospital setting: admin meds, monitor for therapeutic and adverse effects,
- monitor for signs of excess fluid volume, evidenced of electrolyte imbalance.
- promote oxygenation, balance activity with rest,
- support family members
158
Medical Management of HF
low sodium diet, fluid restrictions, lifestyle changes, exercise, weight loss, cholesterol levels.
159
drug therapy for HF is
digitalization- digoxin/lanoxin- slows and strengthens beat of heart
*0.8-2.0
160
Acute HF or pulmonary edema
| Interventions:
potent inotropic agent: dopamine(intropin), dobutamine (dobutrex)
diuretic therapy: furosemide (Lasix)
-Vasodilators, ACE inhibitor:catopril (capoten), Ramipril (altace)
161
Medical Management of HF
CRT (cardiac resynchronization therapy)
| IABP (intra-aortic balloon pump)
162
___ ____ ___ restores synchrony in contractions of the right and left ventricles
CRT (cardiac resynchronization therapy
163
temporary, secondary mechanical circulatory pump to supplement the ineffectual contraction of the left ventricle
Intra Aortic balloon pump IABP
164
an elderly client has had a myocardia infarction of the right side of the heart. Which of the following signs should the nurse anticipate when assessing for HF
edema in feet and legs
165
surgical tx for heart failure
VAD (ventricular assist device)
| Cardiomyoplasty (lastissimus dorsi)
166
auxiliary heart pump that supplements the hearts ability to eject blood, destination therapy, which Is a mechanical circulatory support when there is no option for a heart transplant.
Ventricular assist device (VAD)
167
___ is grafted to the aorta and wrapped around the heart.
| -electrical stimulator placed in the subcutaneous pouch triggers skeletal muscle contraction
cardiomyoplasty (latissimus dorsi)
168
HF surgical TX
SVR (surgical ventricular restoration)
| TAH Total artificial Heart
169
___ ___ ___ decreases the size of the heart to a near normal size and shape by removing dysfunctional heart muscle that does not contract properly
surgical ventricular restoration (SVR)
170
__ __ ___ electronically powered pump that circulates blood into the pulmonary artery and the aorta.
-replacing the functions of both right and left ventricles
total artificial heart (TAH)
171
which of the following client teaching posts should be included in the discharge planning of a client who has a HF
weigh yourself daily
172
a client may be at risk for impaired gas exchange related to pulmonary congestion secondary to left ventricular dysfunction. A nursing intervention to assist client with maintaining adequate gas exchange includes the following
- maintaining the client in high fowlers position
- administering supplemental o2
- limit physical activity
173
the left ventricle incapable of maintaining sufficient blood output is
Cardiogenic pulmonary edema.
174
Assessment finding of cardiogenic pulmonary edema
sudden dyspnea, wheezing, orthopnea, restlessness, cough (productive of pink, frothy, sputum), cyanosis, tachycardia, severe apprehension, respirations sound moist or gurgling, hypotensive, peripheral pulses disappear.
DX findings: chest radiographs:pulmonary infiltration: ABGS indicate hypoxemia, hypercapnia, and PH below 7.35
175
Medical Management of cardiogenic pulmonary edema
Supplemental o2 or mechanical ventilation
- drug therapy: dopamine (Intropin), dobutamine (Dobutrex), digitalis, diuretics, nitrates, ace inhibitors, calcium channel blockers, morphine
- IABP, biventricular pacemaker, LVAD, cardiomyoplasty, artificial heart.
176
nursing management of Cardiogenic pulmonary edema
establishes IV line immediately for medication admin, bed side ECG monitoring, pulse ox, automatic bP , and pulse measurements, urinary catheter used to measure output, oxygenation, frequent mouth care.
