CAD & ACS & CHF Flashcards

Question

Nursing management of HF

Answer 1

Interventions to address: - Activity intolerance - Decreased CO - Excess fluid volume (fluid restriction) - Fatigue - Impaired gas ex - Ineffective health maintenence - Fear

Answer 2

Class I - no limit of physical act Class II - Slight limitation of physical activity, no symptoms at rest, ordinary physical activity results in fatigue, dyspnea, palpations, or angina Class III - Limits of physical act, comfortable at rest. Ordinary physical activity causes fatigue, dyspnea, palpations, or angina Class IIII - Inability to carry on any physical activity w/o discomfort. symptoms of cardiac insufficiency or of angina may be present even at rest. If any physical activity is undertaken, discomfort is increased

Answer 3

Physio - Valve leaflet prolapse or "buckle" back into LA during systole - Usually benign Manifestation -Palpitations d/t dysrhythmias - PVCs, PSVT, VT - +/- chest pain - Prophylactic antibiotics

Answer 4

adult causes from rheumatic heart disease obstruction increase left atrial pressure and volume hypertrophy of pulmonary vessels chronic LA pressure elevation Physio Increase in LA pressure/volume Increased pulmonary pressure Hypertrophy of pulmonary vessels Manifest Exceptional dyspnea Fatigue Palpitations (AFib) Hoarseness - LA pressing on laryngeal nerve Chest pain Seizure/stroke

Answer 5

Causes MI Chronic rheumatic heart disease Mitral valve prolapse Ischemic papillary muscle dysfunction Infective endocarditis Physiology Incomplete valve closure during systole Blood flows backward from LV to LA LV & LA work harder to maintain C.O. (Chronic) LA enlargement LV hypertrophy Decrease in C.O. Symptoms Weakness Fatigue Palpitations Dyspnea gradually progresses to Orthopnea Paroxysmal nocturnal dyspnea Peripheral edema ACUTE manifestations Thready pulses Cool, clammy extremities Low C.O. may mask murmu Sudden – Pulmonary edema & cardiogenic shock CHRONIC manifestations May be asymptomatic for years until development of some degree of LV failure Weakness / fatigue Palpitations Progressive dyspnea

Answer 6

Congenital: Usually childhood, adolescence, or young adulthood Later in life usually Rheumatic fever Fusion of commissures Calcification of leaflets (Stiffness, retraction) Accompanied by MV disease Senile fibrocalcific degeneration of normal valve Isolated AS almost always non-rheumatic Obstruction of flow from LV to aorta during systole Reduced C.O. – decreased tissue perfusion Pulmonary HTN – Heart failure Effect LV hypertrophy ↑ myocardial oxygen consumption d/t ↑ mass ↓ CO & pulmonary HTN Clinical manifestations Angina Syncope Exertional dyspnea Triad = LV failure Poor prognosis Symptoms Obstruction not relieved Nitroglycerin contraindicated** Reduces preload

Answer 7

Congenital: Usually childhood, adolescence, or young adulthood Later in life usually Rheumatic fever Fusion of commissures Calcification of leaflets (Stiffness, retraction) Accompanied by MV disease Senile fibrocalcific degeneration of normal valve Isolated AS almost always non-rheumatic Obstruction of flow from LV to aorta during systole Reduced C.O. – decreased tissue perfusion Pulmonary HTN – Heart failure Effect LV hypertrophy ↑ myocardial oxygen consumption d/t ↑ mass ↓ CO & pulmonary HTN Clinical manifestations Angina Syncope Exertional dyspnea Triad = LV failure Poor prognosis Symptoms Obstruction not relieved Nitroglycerin contraindicated** Reduces preload

Answer 8

May result from disease of aortic valve leaflets, aortic root, or both Caused by Infective endocarditis Trauma Aortic dissection Chronic AR results from Rheumatic heart disease Congenital bicuspid aortic valve Syphilis Chronic rheumatic heart conditions Acute manifestations Sudden manifestations of CV collapse Severe dyspnea & chest pain Hypotension LV failure Cardiogenic shock Chronic manifestations May be asymptomatic for years Progressive exertional dyspnea “Water-hammer” pulse A strong quick beat that collapses immediately Physiology Retrograde blood flow from ascending aorta to left ventricle Results in volume overload Left ventricle compensates by dilation & hypertrophy Myocardial contractility eventually declines Pulmonary hypertension & right ventricular failure develop Clinical manifestations of sudden cardiovascular collapse Left ventricle exposed to aortic pressure during diastole Sudden weakness Severe dyspnea Chest pain Hypotension Constitutes a medical emergency

Answer 9

Timing Shape Location Radiation Intensity Pitch Quality Grade 1 – Very faint Grade 2 – Soft Grade 3 – Heard all over the precordium Grade 4 – Loud, with palpable “thrill” Grade 5 – Very loud, with palpable “thrill” May be heard with stethoscope partially off chest Grade 6 – Very loud, with thrill May be heard with stethoscope entirely off chest

Answer 10

History & physical exam Chest x-ray ECG Cardiac catheterization Echocardiogram & Doppler flow studies Evaluation of cardiac wall motion (function) Detect valvular heart disease Stress testing Identify / quantify pericardial fluid Color doppler imaging demonstates direction & velocity of blood flow TEE: Trans-esophageal echocardiography Patent ductus arteriosus (PDA)

Answer 11

Digoxin (positive inotrope) Vasodilators Diuretics -Blockers Other drug therapies Anti-coagulants Anti-arrythmics Low-sodium diet

Answer 12

Objective data Abnormal heart sounds Tachycardia Dysrhythmias Hypotension Hepatomegaly Diaphoresis Peripheral edema Ascites Crackles, wheezes, hoarseness

CAD & ACS & CHF Flashcards

(36 cards)