Cardiac Flashcards
(130 cards)
1
Q
function of the SA node
A
pacemaker
60-100 beats/min
2
Q
function of the AV node
A
receives impulses from SA node
if SA node fails, AV node starts
40-60 beats/min
3
Q
function of purkinje fibers
A
acts as pacemaker when SA and AV nodes fail
20-40 beats/min
4
Q
what happens when the coronary arteries are blocked?
A
increased risk of MI
5
Q
heart sounds
A
1st (S1): heard at apex of heart
2nd (S2): heard at base of heart
3rd (S3): occurs with heart failure and regurg
4th (S4): atrial asystole, abnormal, causes cardiac hypertrophy disease or injury
6
Q
sinus tach
A
> 100 beats/min
faster the heart rate the less cardiac output
7
Q
sinus brady
A
<60 beats/min
treat if patient is symptomatic (decreased cardiac output)
low HR is normal for athletes
8
Q
what does renin do?
A
vasoconstriction
increases BP
9
Q
what does vasopressin (ADH) do to BP
A
ADH influences regulation of vascular volume.
when there is an increase blood volume less ADH will be released, increase urination, decreasing blood voulme and BP
when there is a decrease in blood volume more ADH will be released, which promotes blood volume to increase and increase BP
10
Q
arteries
A
take oxygenated blood AWAY from heart
11
Q
veins
A
transport deoxygenated blood to the heart
12
Q
troponin
A
protein that increases with an MI
rises within 3 hours and last 7-10 days
normal level < 0.3
13
Q
myoglobin
A
oxygen binding protein that rises within 2 hrs of cell death
14
Q
RBC
A
4.2-6.1
decreases in rheumatic heart disease and infective endocarditis
increases in conditions where there is an inadequate tissue oxygenation
15
Q
WBC
A
5-10
increases with infection and inflammation and after MI
16
Q
H&H
A
hgb 12-18
hct 32-57
elevated hct: vascular volume depletion
decreased H&H: anemia
17
Q
effects of potassium on the heart
A
hypokalemia: ventricular dysrythmias and increase risk of dig toxicity. flat and inversed T wave, U wave, and depression of ST
hyperkalemia: asystole and ventricular dysrhythmia. tall peaked T wave, wide QRS complex, prolonged PR intervals, flat P waves
18
Q
effects of sodium on heart
A
decreases with diuretics
decreases with heart failure
19
Q
effects of calcium on heart
A
hypocalcemia: ventricular dysrhythmias, prolonged ST and QT interval, and cardiac arrest
hypercalcemia: short ST segment and wide T wave, AV block, tachycardia or bradycardia, dig hypersensitivity and cardiac arrest
20
Q
effect of phosphorus on heart
A
interpreted with calcium levels because kidney retain or excrete one or the other
when calcium is high phosphorus is low or vice versa
21
Q
effects of mag on heart
A
low mag: vtach or vfib
tall T wave
depressed ST segment
high mag: muscle weakness hypotension and bradycardia.
long PR interval
wide QRS
22
Q
BUN and heart
A
elevated BUN with heart failure and cardiogenic shock due to effects on renal circulation
23
Q
BNP
A
anything >100 is heart failure
24
Q
meanings of the ECG components
A
reflects electrical activity of cardiac cells and record electrical activity
P wave: atrial depolarization
PR interval: time it take impulse to get from atria to AV nose bundle of his to purkinje fibers (0.12-0.2 sec)
QRS complex: ventricular depolarization (0.04-0.1 sec)
ST segment: early ventricular repolarization
T wave: ventricular repolarization
U wave: follows T wave and indicates electrolyte issues
QT interval: total time required for ventricular depolarization and repolarization (0.32-0.4)
25
ECG
noninvasive diagnostic test that records electrical activity of the heart
used to detect cardiac issues, location and extent of MI and cardiac hypertrophy
26
ECG interventions
```
lie still
breathe normally
no talking
electrical shocks will NOT occur
document any heart meds the patient is taking
```
27
holter monitoring
noninvasive
patient wear monitor that continously records ECG
identifies dysrhythmias
evaluates effectiveness of antidysrhytmic meds or pacemaker
28
holter monitor care
resume normal daily activities
maintain diary of activities and s/s that develops
avoid tub baths or showers
29
echocardiography
noninvasive ultrasound that evaluates structural and functional changes in the heart
used to detect vale issues, congenital heart defects, wall motion, ejection fraction and cardiac function
30
echocardiography care
lie still
breathe normally
no talking
31
stress test
noninvasive test that studies the heart during activity
detects and evaluates coronary artery disease
treadmill test is most common
if patient can NOT tolerate exercise; IV dipyridamole or dobutamine is give to dilate coronary arteries and simulate effect of exercise: patient is NPO 3-6 hrs before test
32
before the stress test
informed consent (if using IV option)
adequate rest the night before
light meal 1-2 hrs before
no smoking, ETOH, caffeine
check with MD about which meds to hold
(usually calcium channel blockers and beta blockers are held the day of the test)
wear loose comfy clothes and supportive shoes
report to MD any chest pain, dizziness, SOA
33
after stress test
no hot bath or shower for at least 1-2 hrs after
34
before an MRI
check to see if patient has a pacemaker or other implanted devices that would be contraindicated
remove all metallic objects
may have claustrophobia due to tight space
35
cardiac cath
invasive test involving insertion of catheter into heart
36
before cardiac cath
informed consent
assess for allergies to seafood iodine or dye (may be given antihistamines and steroids to prevent reaction)
NO solid food 6-8 hrs before and NO fluids 4 hrs before to prevent aspiration and vomiting
ht and wt to determine amount of dye needed
baseline VS
check pulses
inform about local anesthetic
may feel fluttery feeling as catheter passes through heart
flushed and warm feeling when dye injected
desire to cough and palpitations caused by irritated heart
shave and clean site with antiseptic solution
37
metformin and dye
withhold metformin for 24 hrs before procedures with dye because it can lead to lactic acidosis
not to be given again until after procedure when MD says it is ok or when renal function is evaluated (usually 48 hrs)
38
after cardiac cath
```
check VS and heart rhythm at least q 30 mins for 2 hrs
check for chest pain
report chest pain and dysrhythmias
check pulses and color of extremities
report numbness and tingling
report cool pale or cyanotic extremity
report loss of pulses
sandbag or compression device
check for bleeding
if bleeding: apply manual pressure ASAP and report
check for hematoma and report ASAP
keep extremity extended for 4-6 hours (leg needs to stay straight)
bed rest for 6-12 hrs
HOB NO HIGHER THAN 15 DEGREES
increase fluids
```
39
percutaneous transluminal coronary angioplasty
| PTCA
invasive nonsurgical
arteries are opened up with balloon catheter to improve blood flow
patient needs to completely stop smoking, change diet, lose weight, LIFESTYLE CHANGES
40
before the percutaneous transluminal coronary angioplasty (PTCA)
SAME AS CARDIAC CATH
report chest pain during balloon inflation
may be given aspirin before
informed consent
assess for allergies to seafood iodine or dye (may be given antihistamines and steroids to prevent reaction)
NO solid food 6-8 hrs before and NO fluids 4 hrs before to prevent aspiration and vomiting
ht and wt to determine amount of dye needed
baseline VS
check pulses
inform about local anesthetic
may feel fluttery feeling as catheter passes through heart
flushed and warm feeling when dye injected
desire to cough and palpitations caused by irritated heart
shave and clean site with antiseptic solution with antiseptic solution
41
after the percutaneous transluminal coronary angioplasty (PTCA)
```
SAME AS CARDIAC CATH
give anticoags and antiplatelets
IV nitro
increase fluids
daily aspirin
lifestyle changes
```
```
check VS and heart rhythm at least q 30 mins for 2 hrs
check for chest pain
report chest pain and dysrhythmias
check pulses and color of extremities
report numbness and tingling
report cool pale or cyanotic extremity
report loss of pulses
sandbag or compression device
check for bleeding
if bleeding: apply manual pressure ASAP and report
check for hematoma and report ASAP
keep extremity extended for 4-6 hours (leg needs to stay straight)
bed rest for 6-12 hrs
HOB NO HIGHER THAN 15 DEGREES
increase fluids
```
42
coronary artery stents
used in conjunction with PTCA to eliminate risk of vessel closure and improve vessel long term
reopening of blocked vessels
43
care for coronary artery stents
major concern is thrombosis (clot formation)
antiplatelets (clopidogrel or aspirin) months before
check for complications: stent migration or occlusion, coronary artery dissection, bleeding from anticoags
```
similar to PTCA
check VS and heart rhythm at least q 30 mins for 2 hrs
check for chest pain
report chest pain and dysrhythmias
check pulses and color of extremities
report numbness and tingling
report cool pale or cyanotic extremity
report loss of pulses
sandbag or compression device
check for bleeding
if bleeding: apply manual pressure ASAP and report
check for hematoma and report ASAP
keep extremity extended for 4-6 hours (leg needs to stay straight)
bed rest for 6-12 hrs
HOB NO HIGHER THAN 15 DEGREES
increase fluids
```
44
atherectomy
removes plaque from artery
| improves blood flow to limbs in patients with PAD
45
atherectomy care
cheek for complications of perforation, embolus, or re-occlusion
```
similar to PTCA
check VS and heart rhythm at least q 30 mins for 2 hrs
check for chest pain
report chest pain and dysrhythmias
check pulses and color of extremities
report numbness and tingling
report cool pale or cyanotic extremity
report loss of pulses
sandbag or compression device
check for bleeding
if bleeding: apply manual pressure ASAP and report
check for hematoma and report ASAP
keep extremity extended for 4-6 hours (leg needs to stay straight)
bed rest for 6-12 hrs
HOB NO HIGHER THAN 15 DEGREES
increase fluids
```
46
transmyocardial revascularization
for patients with widespread atherosclerosis in vessels that are too small
uses high power laser that creates 20-24 channels that provide region of heart with oxygenated blood
47
peripheral arterial revascularization
increases arterial blood flow to limbs
| bypassing occlusions
48
before the peripheral arterial revascularization
check baseline VS and pulses
insert IV and foley
maintain central line or art line
49
after the peripheral arterial revascularization
check VS and report changes
check for hypotension: hypovolemia
check for hypertension: stress on graft and causes clot
bed rest for 24 hrs
keep affected extremity stright
limit movement
no bending at knee or hip
check for warm, red, edema: EXPECTED OUTCOMES that means there is an increased blood flow to area
check for graft occlusion
check pulses , changes in color and temp
check incision for drainage, warmth or swelling
small amount of bleeding is EXPECTED
too much bleeding is bad
check graft for infection: hardness, tender, warm and report to MD
foot care and ulcer prevention
modify lifestyle
MONITOR FOR SHARP INCREASE IN PAIN BECAUSE THIS IS THE FIRST INDICATOR OF POSTOP GRAFT OCCLUSION: NEEDS TO BE REPORTED TO MD
50
coronary artery bypass grafting (CABG)
bypassing of an occluded artery
| used when patient does NOT respond to medical management of coronary artery disease
51
before the coronary artery bypass grafting (CABG)
expect sternal incision, chest tubes, foley, and multiple IV sites
ET tube placed for a short time and pt will not be able to speak
will be mechanical vented
patient needs to breathe with vent and not fight it
discontinue certain meds: diuretics 2-3 days before, dig 12 hrs before, aspirin and anticoags 1 week before
give potassium, antihypertensives, antidysrhythmics, and antibiotics
52
after the coronary artery bypass grafting (CABG)
mechanical vent
monitor HR, rhythm, urine output, and neuro status
report chest tube drainage greater than 75 ml/ht
monitor fluid and electrolytes
fluid restriction d/t edema
hypotension collapses graft
hypertension promotes leakage causing bleeding
check temp
rewarm patient using warm thermal blankets if temp less than 96.8
rewarm no faster than 1.8 degrees/hr to prevent shivers
discontinue rewarming when temp gets to 98.6
IV potassium to maintain potassium between 4-5
check s/s cardiac tamponade: sudden cessation of heavy mediastinal drainage, JVD with clear lung sounds, equalization of right atrial pressure and pulmonary wedge pressure, and pulsus paradoxus
53
pulsus paradoxus
abnormally large decrease in stroke volume and bp during inspiration
54
transfer patient from the CICU
```
check VS
check LOC
check perfusion
check for dysrhythmias
listen to lungs
assess respiratory
spline incision
cough deep breathe and IS to prevent atelectasis
check temp
check WBC
give fluids to liquefy secretions
assess suture line and chest tube insertion for infection
assess sternal suture for infection
gradually resume activity
assess for tachycardia, ortho hypotension and fatigue
discontinue activities if BP drops more than 10-20 mm Hg or if pulse increase more than 10 beats/min
```
55
heart transplant
donor heart must have comparable body weight and ABO compatibility
transplanted within less than 6 hrs
will have 2 unrelated P waves on ECG because part of atria is left in from old heart
new heart is denerved and does NOT respond to vagal stimulation (will not have angina d/t denerving of heart)
endomyocardial biopsies performed regularly and when rejection expected
required lifetime immunosuppressives
strict aseptic technique and hand washing
56
s/s heart rejection
```
hypotension
dysrhythmias
weakness
fatigue
dizziness
```
57
home care for patients with cardiac surgery
```
slowly return to activities
limit pushing or pulling activities for 6 wks
monitor incision for infection
sternal incision should heal 6-8 wks
no crossing legs
no panty hose till edema is gone
no elevating surgical limb when sitting
no saturated fats
no cholesterol
no salt
can resume sex if patient can walk 2 block or climb 2 flights of stairs without s/s
```
58
normal sinus rhythm
SA nose
| 60-100 beats/min
59
sinus brady interventions
```
determine cause of brady
if med is causing brady: withhold med and notify MD
give O2
give atropine to increase HR
transcutaneous pacemaker if atropine does NOT work
NO extra atropine: causes tachycardia
check for hypotension and give fluids
may need permanent pacemaker
```
60
sinus tach interventions
find the cause
| decrease HR to normal by treating cause
61
a fib
multiple rapid impulses from multiple atrial depolarizations
atria quivers leading to thrombi
no P wave; just wiggly lines before the QRS
62
a fib interventions
give O2
give anticoags
give cardiac meds to control ventricular rhythm and assist in maintenance of cardiac output
cardioversion
63
PVC premature ventricular contractions
early ventricular contractions resulting from increase irritability of ventricles
unifocal or multifocal QRS
upside down QRS
64
PVC premature ventricular contractions interventions
ID cause and treat
check O2 sat for hypoxia: can cause PVC
check electrolytes (potassium): can cause PVC
O2 and meds in cause of acute MI
NOTIFY MD IF PATIENT COMPLAINS OF CHEST PAIN OR IF PVCS INCREASE IN NUMBER ARE MULTIFOCAL OCCURE ON T WAVE OR OCCUR IN RUNS OF VTACH
65
v tach
repetitive firing of irritable ventricles
leads to cardiac arrest
66
stable patients with sustained vtach
with pulse and no s/s of decreased cardiac output
give O2
give antidysrhythmics
67
unstable patient with vtach
with pulse and s/s of decreased cardiac output
give O2
give antidysrhythmics
cardioversion if patient is unstable
cough CPR: coughing hard every 1-3 secs
68
pulseless patient with vtach
defib and CPR
69
vfib
chaotic rapid rhythm where ventricles quiver and there is NO cardiac output
fatal if not stopped within 3-5 mins
lack pulse, BP, respirations, heart sounds, and is unconscious
70
vfib interventions
```
CPR until defibrillator gets there
check entire length of patient 3 times to make sure no one is touching the patient or the bed
when clear: defib
CPR another 2 mins
reassess cardiac rhythm
give O2
give antidysrhythmic
```
71
vagal maneuvers
induce vagal stimulation to terminate SVTs
72
carotid sinusmassage
instruct patient to turn head away from side that is being massaged
massage 1 carotid for a few seconds to determine change in rhythm
patient must be on cardiac monitor
check ECG strips before during and after
document
have defibrillator and CPR equipment at bedside
check VS, cardiac rhythm, and LOC after
73
valsalva maneuver
instruct patient to bear down or induces gag reflex to stimulate vagal response
check HR, rhythm, BP
record ECG before during and after
provide emesis basin if gag reflex is stimulated
aspiration precautions
have defib and CPR equipment in room
74
cardioversion
synchronized countershock to convery undesirable rhythm to stable
75
pre-cardioversion
if elective, ensure informed consent is obtained
if elective hold dig for 48 hrs before
if elective for afib or aflutter: patient should get anticoags for 4-6 weeks before
give sedative
76
during cardioversion
ensure skin is clean and dry in area where electrode pads will be placed
stop O2 to avoid fire hazard
make sure no one is touching the bed or patient when giving the shock (check 3 times before shocking)
77
post-cardioversion
```
priority: maintain airway and breathing
resume O2
check VS
check LOC
check cardiac rhythm
check for indications of successful response: conversion to sinus rhythm, strong pulses, adequate BP and urine output
check skin on chest for burns from pads
```
78
defib
countershock for pulseless vtach and vfib
1 defib then 5 cycles (2mins) of CPR
reassess after 2 mins
shock again
BEFORE SHOCKING MAKE SURE O2 IS TURNED OF TO AVOID FIRE HAZARD AND BE SURE THAT NO ONE IS TOUCHING THE BED OR THE PATIENT
79
pad electrodes
1 pad on 3rd intercostal space to right of sternum
1 pad on 5th intercostal space on left of midaxillary line
apply firm pressure to each pad (25lbs)
make sure no one is touching bed or patient for shock
80
AED
place patient on firm dry surface
stop CPR
make sure no one is touching patient or bed
place electrode patches in correct spots
press analyzer button
shock for pulseless vtach or vfib ONLY (up to 3 shocks)
if unsuccessful, CPR is continued for 1 min and the another 3 shocks are given
81
automated implanted cardioverter-defibrillator
monitors cardiac rhythm and detects and terminated episodes of vtach and vfib
used in patients with episodes of spontaneous sustained vtach or vfib
planted in left pectoral
82
automated implanted cardioverter-defibrillator education
wear loose fitting clothes
avoid contact sports to prevent trauma
report fever redness welling or drainage from site
report fainting nausea weakness blackouts and rapid pulse rates
during shock discharge, patient may feel faint or short of breath
instruct patient to sit or lie down if they feel a shock and report
maintain log of date time and activity before the shock, s/s before shock, and postshock sensations
encourage family to learn CPR
avoid electromagnetic fields (airport security)
move away from magnetic fields if beeping tones are heard and report
83
pacemakers
device that provide electrical stimulation and maintains the HR when patient's heart can no longer be the pacemaker
84
temporary pacemaker: noninvasive transcutaneous pacing
used as temporary emergency measure in patients with profound bradycardia or asystole
electrode pads placed on check and back and connected to external generator
wash skin with soap and water before applying electrodes
no need to shave hair or apply alcohol
posterior electrode goes between the spine and left scapula behind the heart: avoid placing on bone
place anterior electrode between V2 and V5 positions over the heart: do not place over female breast tissue, place under breast
do not take pulse or BP on left side
set pacing rate
85
temporary pacemaker: invasive transcutaneous pacing
pacing lead wire placed through antecuital, femoral, jugular, subclavian vein into right atrium or right ventricle
check insertion site
restrict patient movement to prevent displacement
86
reducing risk of microshock
use only inspected and approved equipment
insulate exposed portion of wires to plastic or rubber (rubber gloves)
ground all electrical equipment using 3 pronged plug
wear gloves when handling wires
keep dressings dry
VS ARE MONITORED AND CARDIAC MONITORING IS DONE CONTINUOUSLY FOR CLIENT WITH PACEMAKER
87
permanent pacemakers
surgical implantations in subcutaneous pocket below clavicle
limit arm movement postop to prevent wire dislodgement
powered by lithium battery with average life span of 10 years
88
pacemaker education
teach about programmed rate
teach s/s of battery failure and when to report to MD
report fever, redness, swelling, or drainage
report dizziness, weakness, fatigue, swelling of ankles or legs, chest pain, or SOA
teach how to take pulse
take pulse daily and keep diary
wear loose fitting clothes over site
no contact sports
inform all HCP that pacemaker is inserted
inform airport security about pacemaker because it will set off the alarms
most electrical appliances can be used without interference
do not operate electrical appliances directly over pacemaker
avoid transmitter towers and anti-theft devices in stores
move 5-10 feet away and check pulse if unusual feelings occur near electrical devices
important to follow up with MD
use cellphones on opposite side of the pacemaker
89
coronary artery disease
narrowing or obstruction of arteries d/t atherosclerosis
causes decreased perfusion and inadequate O2 supply
leads to HTN, angina, dysrhythmias, MI, heart failure, death
90
coronary artery disease s/s
```
chest pain
palpitations
dyspnea
syncope
cough or hemoptysis
excessive fatigue
```
can lead to ischemia of the heart
91
coronary artery disease diagnostic tests
ECG
cardiac cath
blood lipid levels
92
coronary artery disease care
```
find risk factors that can be modified
set goals to promote lifestyle changes
low calorie low sodium low cholesterol low fat diet
increase fiber
dietary changes are for life
increase exercise
stop smoking
reduce stress
```
93
coronary artery disease meds
nitrates
calcium channel blockers
cholesterol lowering meds
beta blockers
94
angina
chest pain from heart ischemia from lack of blood and O2 to heart
95
goal of angina treatment
provide relief from acute attack, correct imbalance between heart O2 supply and demand, and prevent progression of disease and further attacks to reduce risk of MI
96
stable angina
occurs with activities that involves exertion or emotional stress
relieved with rest or nitro
stable pattern
97
unstable angina
unpredictable degree of exertion or emotion
increases in occurrence duration and severity
NOT RELIEVED WITH NITRO
98
variant angina
from coronary artery spasm
occurs at rest
associated with ST segment elevation on ECG
99
intractable angina
chronic incapacitating angina that does NOT respond to treatment
100
preinfarction angina
acute coronary insufficiency
last longer than 15 mins
s/s of worsening cardiac ischemia
chest pain that occurs days to week before MI
101
angina s/s
substernal crushing squeezing pain
pain may radiate to shoulders, arms, jaw, neck, back
pain usually lasts less than 5 mins but can last up to 15-20 mins
pain relieve by nitro and rest
```
dyspnea
pallor
sweating
palpitations
tachycardia
dizzy
syncope
hypertension
digestive issues
```
102
angina diagnostic
```
ECG
stress test
cardiac enzyme
troponin
cardiac cath
```
103
angina care
```
give nitro
cardiac monitoring
give O2
bed rest
semi fowlers
stay with patient
obtain 12-lead ECG
get IV access
```
104
acute angina episode
```
stop activity
rest
nitro
call 911 if nitro does not relieve pain
aspirin
```
105
MI
ischemia that leads to necrosis
| infarction occurs over several hours
106
MI diagnostics
troponin level rise w/in 3 hrs and remains elevated for 7-10 days
CK level
WBC count
ECG
107
MI s/s
women experience atypical s/s: SOA and fatigue
crushing substernal pain that radiate to jaw back and left arm
pain without cause (early in the AM)
pain unrelieved by rest or nitro
only relieved by opioids
pain lasts 30 mins or longer
```
n/v
sweating
dyspnea
dysrhythmias
fear
anxiety
pallor
cyanosis
cool extremities
```
108
MI care
PAIN RELIEF INCREASES O2 SUPPLY TO HEART; GIVE MORPHINE AS PRIORITY IN MANAGING PAIN TO PATIENT WITH MI
MONA: morphine, O2, nitro, aspirin
check RR, HR
check for crackles or wheezes or edema
bed rest
semi fowlers
stay with patient
get IV access
obtain 12-lead ECG
check for tachycardia or PVCs because they occur hours after MI: give antidysrhythmics
give anti thrombolytic and check for bleeding
check pulses and skin temp because poor cardiac output (cool sweaty skin and decreased pulses)
check BP
give beta blockers to slow HR and increase myocardial contraction
109
acute MI episode
bed rest
stand to void or use bedside commode
ROM exercises to prevent thrombus formation
maintain muscle strength
progress to dangle legs at side of bed or out of bed to chair for 30 mins 3 times/day
progress to ambulation in patients room and to bathroom and then hallway 3 times/day
check for complications
give ACE, ARBs, calcium channel blockers, aspirin, clopidogrel, lipid lowering meds
110
heart failure
impaired pumping ability that leads to inability of heart to maintain adequate cardiac output
decreased tissue perfusion
111
right sided heart failure
```
edema
JVD
abdominal distention
hepatomegaly
splenomegaly
anorexia
nausea
weight gain
nocturnal diuresis
swelling of fingers and hands
increased BP from increased fluid volume
decreased BP from pump failure
```
112
left sided heart failure
```
pulmonary congestion
dyspnea
tachypnea
tachycardia
crackles
nasal flaring
use of accessory muscles
wheezing
blood frothy sputum
dry hacking cough
nocturnal dyspnea
cold clammy skin
cyanosis
increased BP from increased fluid volume
decreased BP from pump failure
```
113
pulmonary edema priority nursing actions
```
high fowlers
legs in dependent position
high flow O2
assess lung sounds
get IV access
give diuretic (furosemide) and morphine
insert foley
prepare for intubation and vent
document
```
can give dig and bronchodilators
114
after acute episode with heart failure
```
dig
diuretics
ace inhibitor
beta block
vasodilator
no OTC
no large amounts of caffeine (coffee, tea, cocoa, chocolate, carbonated drinks)
eat K+ rich foods
fluid restriction
suck on hard candy to reduce thirst
rest periods
avoid isometric activities
daily weights
report signs of fluid retention (edema or weight gain)
```
115
cardiogenic shock
failure of heart to pump
goal of treatment is to maintain tissue oxygenation and perfusion and improve pumping of heart
116
cardiogenic shock s/s
```
hypotension
decreased urine output
cold clammy skin
poor pulses
tachycardia
tachypnea
pulomonary congestion
restless
chest discomfort
```
117
cardiogenic shock care
```
give O2
give morphine IV
intubation and mechanical vent
give diuretics and nitrates
give vasopressors and inotropes
check ABGs
check urinary output
```
118
central venous pressure
pressure within SVC
| pressure in which blood is returned to SVC
119
measure CVP
transducer needs to be at level of right atrium
position supine with HOB at 45 degrees
no coughing or straining
to maintain patency: continuous small amount of fluid delivered under pressure
120
mean arterial pressure (MAP)
60-70
121
pericarditis
inflammation of pericardium
| pericardial sac becomes inflamed
122
pericarditis s/s
anterior chest pain that radiates to left side of neck, shoulder, or back
pain made worse by breathing, coughing, swallowing
pain worse in supine position and relieved by leaning forward
pericardial friction rub
fever
chills
fatigue
elevatedWBC
ECG changes (ST elevation, afib)
123
pericarditis care
high fowlers or upright and leaning forward
give O2
give pain meds (NSAIDs or steroids)
listen for pericardial friction rub
check blood cultures to find cause
give antibiotics for bacterial infection
give diuretics and dig
check for cardiac tamponade and report to MD
124
myocarditis
inflammation of myocardium d/t pericarditis, systemic infection, or allergies
125
myocarditis s/s
```
fever
dyspnea
tachycardia
chest pain
pericardial friction rub
gallop rhythm
murmur that sounds like fluid passing an obstruction
pulsus alternans
s/s heart failure
```
126
myocarditis care
```
sit up and lean forward
give O2
pain meds, aspirin, NSAIDS
dig
antidysrhythmics
antibiotics
check for complications: thrombus, heart failure, cardiomyopathy
```
127
endocarditis
inflammation of inner lining of the heart and valves
IV drug abusers (need a replacement valve)
128
endocarditis s/s
```
fever
anorexia
weight loss
fatigue
cardiac murmurs
heart failure
vegetation fragments
petechiae
splinter hemorrhages on nail beds
oslers nodes (red tender lesions on pad of fingers, hands, toes)
janeway lesions (nontender hemorrhagic lesions)
splenomegaly
clubbing of fingers
```
129
endocarditis care
schedule rest
antiemolism stockings
check for s/s heart failure
check for splenic emboli (sudden abdominal pain radiating to left shoulder and presence of rebound abdominal tenderness)
check for renal emboli (flank pain radiating to groin, hematuria, and pyuria)
check for confusion, aphasia, or dysphasia
check for pulmonary emboli
check blood cultures
give antibiotics
130
endocarditis education
aspetic technique during setup and administration of IV antibiotics
IV antibiotics are scheduled
check IV site for s/s infection
report s/s infection
record daily temp for up to 6 weeks
report temp
oral hygiene twice a day with soft tooth brush
rinse well with water after brushing
avoid oral irrigation devices and flossing
cleanse skin lacerations and apply antibbiotic ointment
inform all HCPs about condition and get prophylactic antibiotics before respiratory and dental procedures
