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Nursing 3910 > Week 8: CIRCULATION & PERFUSION II > Flashcards

Week 8: CIRCULATION & PERFUSION II Flashcards

1
Q

Coronary Artery Disease (CAD)

A

Narrowing or obstruction of the coronary arteries as a result of atherosclerosis

Buildup of plaque in arterial walls

  • Caused by injury to artery walls (HTN, diabetes, inflammation, high cholesterol)
  • Plaque impacts perfusion, causing damage to body systems
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2
Q

Assessment of CAD

A

Health history:
Family history, Age (increased with age), Gender (women after menopause), Genetics, SDOH, Stress, Alcohol, Smoking, Depression, Signs and symptoms, Comorbidities – HTN, dyslipidemia, diabetes, high BMI

Physical:
Neuro – fatigue, dizziness, anxiety, insomnia

Cardiac – chest pain, cardiac events (palpations, sensations)

GI – indigestion

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3
Q

Labs/Investigations: Coronary artery disease

A

Lipid profile (normal values):
Total cholesterol = under 200
LDL (bad) = under 100
HDL (good) = over 60

Triglycerides = under 150

HbA1C (uncontrolled diabetes)
High = increased risk

BG (uncontrolled diabetes)
High = increased risk

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4
Q

Nursing priorities of CAD

A
  • Control cholesterol
  • Medication
  • Lifestyle changes (low sugar, low saturated fats, high fibre diet)

Manage comorbidities
- Promote blood glucose control
- Promote blood pressure improvement

Health teaching
- Treatment/lifestyle modifications o Interprofessional team (RD)

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5
Q

Stenosis

A

Occurs as a progression of CAD

Stages:
- Clear vessel
- 50% block
- 80% block – blood flow here might be enough during rest when HR is stable, but
when HR increases to meet the demands of activity, not enough blood flow will cause starvation of tissues- May see symptoms in this stage

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6
Q

Myocardial Infarction and Angina

A

Conditions of myocardial ischemia (reduced blood flow to heart muscles)

  • Demand for O2 is greater than the supply of O2
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7
Q

Angina

A

ischemia of partial thickness of myocardial muscle
- Chest pain brought on by myocardial ischemia

Stable – predictable, occurs with exertion, relieved w rest and nitroglycerin

Unstable – unpredictable, occurs w/o exertion, not relieved w rest and nitroglycerin

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8
Q

causes of angina

A

Stenosis
Vasospasm
Thickening of heart wall

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9
Q

tests for angina

A

Negative Cardiac Biomarkers

Negative ECG

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10
Q

Nursing priorities: Angina

A

Pain management & promote perfusion:
- Medication (nitroglycerin), lifestyle changes

PROCESS:
- Stop activity
- Sit in semi-fowlers
- Assess pain
- Administer nitroglycerin
- Re-assess pain
- VS and cardiac assessment
- Apply O2
- Re-assessment

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11
Q

Pharmacological Interventions: angina

A

(target vasodilation, pain relief, and reduce risk of clotting/atherosclerosis):

Nitrates (short acting, long acting)
Calcium channel blockers
Beta blockers
Antihyperlipidemics (statins)
Anti-coagulants

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12
Q

MI - Myocardial infarction

A

ischemia of full thickness of myocardial muscle
- Death of myocardia cells as a result of prolonged ischemia
- EMERGENCY SITUATION

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13
Q

Causes and treatments for MI

A

Causes:
Stenosis
Plaque
Lodge

Goal - restore blood flow

Treatment goals: re-perfusion

STEMI – ST elevation MI
Tests:
- Positive cardiac biomarkers
- Negative ECG

N-STEMI – non-ST elevation MI o Tests:
- Positive cardiac biomarkers
- Positive ECG

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14
Q

Nursing Priorities: MI

A

Nursing priorities:
Re-perfusion:
- PCI (first line intervention), clot busters (thrombolytics)

Pain management:
- O2, morphine, nitroglycerin

Health teaching:
- Medication regime, lifestyle changes

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15
Q

Pharmacological Interventions: MI

A

(target vasodilation, clot busting, pain, reduce risk of future complications):

ASE (Alteplase, Reteplase, Aminolase)
Class - thrombolytic
Action – dissolve thrombus
Caution – bleeding risk
Nursing considerations – IV admin

  • Nitrates
  • Morphine
  • Calcium channel blockers
  • Beta blockers
  • Antihyperlipidemics (statins)
  • Anti-coagulants
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16
Q

Complications (caused by damage to heart muscle): MI

A

Dysrhythmias
Pulmonary edema
Future MI
Cardiogenic shock
Heartfailure

17
Q

Angina & MI Assessment

A

Family hx
Age (increased w age)
Gender
Genetics
SDOH
Stress, alcohol, smoking, depression
Comorbidities: HTN, dyslipidemia, diabetes, high BMI, CHF
Medications – blood thinners, nitroglycerin

18
Q

Signs and symptoms: Angina + MI

A

Anxiety
o Restlessness
o Dizziness
o Chest pain (pressure, squeezing, or other)
o Irregular rhythm
o Bounding pulse
o Pressure in lef arm, jaw, shoulders & back o N/V
o Flush/pale
o Diaphoretic (excessive sweating)
o SOB
o Tachypnea
o Crackles

19
Q

Labs & investigations: Angina + MI

A

ECG (12 lead) – diagnostic test
- Positive – N-STEMI MI
- ST depression – indicator of angina
- No change on ECG – indicator of N-STEMI MI
- ST elevation – indicator of STEMI

Cardiac biomarkers:
- Troponin I (normal = less than 0.03 ng/mL)
–Elevated with cardiac muscle damage
–Elevates 3-6 hours post MI
–Peaks 12-16 hours post MI
–Remains high for 5-9 days following MI

Creatinine
Myoglobin

20
Q

Heart Failure

A

Diseased myocardium
- Cardiac output is decreased, decreasing tissue perfusion
- Chronic condition
- Results in acute decompensation
- Goal: QOL, stabilization

  • Causes dysfunction in:

Systolic (impaired myocardial contraction):
 Contractility issues
 Results from ventricles lacking strength

Diastolic (impaired ventricular filling):
 Compliance/pre-load issue
 Results from ventricles lacking elasticity

21
Q

Stages of Heart Failure

A
  • Stage 1 (asymptomatic)
    Lifestyle modification, ACEi or ARB
  • Stage 2: mild symptoms with ordinary activity
    Lifestyle modification, ACEi or ARBs + beta blocker
  • Stage 3: moderate symptoms w less than ordinary activity
    Lifestyle modification + surgical intervention, ACEi or ARBs + beta blocker + diuretic
  • Stage 4: severe symptoms at rest or w any minimal activity Palliative or heart transplant
22
Q

Causes of Heart Failure:

A
  • HTN
  • MI
  • COPD
  • Cardiomyopathy
  • Valve issues
23
Q

Risk Factors for Heart Failure:

A
  • Family hx
  • Age (increased w age)
  • Gender
  • Genetics
  • SDOH
  • Stress
  • Alcohol
  • Smoking
  • Depression
  • HTN, dyslipidemia, diabetes, high BMI, MI
24
Q

Signs and Symptoms of Heart Failure:

A

Both sides:
Fatigue, organ damage

  • Left side CHF – respiratory congestion, blood backs up in lungs: Dyspnea, SOB, Nocturnal dyspnea, Cough, Crackles, Orthopnea, Decreased SpO2, Extra heart beats/sounds, Palpitations, Dysrhythmias, Increased HR, Weak pulses Dizziness, confusion, restlessness, Altered digestion, Oliguria (w FVO), CKD risk, Pale, cool, clammy skin
  • Right side CHF – peripheral and visceral, blood backs up into body: o FVO
    Peripheral edema
    Weight gain
    o JVD
    o Unstable BP
    o RUQ pain
    o Jaundice, itching
    o Liver dysfunction
    o Anorexia/nausea
    o Reduced RBC production (splenomegaly)
25
Q

Heart Failure: Labs & Investigations

A

B-Type Natriuretic Peptide (BNP)
- Increased value is associated with HF

  • Echocardiogram
    o Measures ejection fraction
    o Normal = 55-65%
    o HFpEF (preserved) = 50-54% o HFmEF (mid-range) = 41-49%
    o HFrEF (reduced) = under 40%
26
Q

Pulmonary Edema

A

Accumulation of fluid in interstitial and alveoli of lungs

  • Can be an EMERGENCY SITUATION (unable to breathe/oxygenate body)

o Can also be chronic

Caused by pulmonary congestion (L side HF)

27
Q

Signs & symptoms: Pulmonary Edema

A

SOB, tachypneic, noisy congested cough, SpO2, cyanosis, frothy pink sputum

JVD, tachycardia, weak peripheral pulses

o Restlessness, anxiety (early), confusion, stupor (late)

28
Q

Nursing Management: Pulmonary Edema

A

Priority – support oxygenation & treat FVO
 High Fowler’s
 Apply O2
 Initiate IV & administer diuretics, morphine
 Monitor ECG
 Provide reassurance

29
Q

Cardiogenic Shock

A

Compromised cardiac function to the point that it cannot maintain CO and adequate
tissue perfusion

30
Q

Signs and symptoms: Cardiogenic Shock

A

Increased HR progressing to decreased BP
Increased RR

Decreased urine output

Pallor, cool

Confusion, agitation

Absence of bowel sounds

  • Treatment: inotropic medications to improve CO
31
Q

Venous Disorders

A

Venous Stasis Ulcers & Cellulitis

Excavation of the skin surface, inflamed and necrotic tissue sloths off (result of inadequate perfusion)

Venous hypertension creates exudate

Nursing management:
- Treat wounds (skin care, nutrition, mobility, infection prevention) - VTE/DVT – may cause pulmonary embolism

32
Q

Nursing Priorities for Heart Failure:

A
  • Fluid balance
    Daily weights, labs (lytes), intake/output measurements
  • Mobility
    Skin integrity, peripheral venous return
  • Health teaching
    Lifestyle, medication, complication monitoring
33
Q

Pharmacological Intervention: Heart Failure

A

(target reduced cardiac workload, reduce symptoms, support cardiac function)

  • Antihypertensives: ACE inhibitors or ARBs
  • Beta blockers
  • Diuretics
  • Digoxin
34
Q

Health Teaching: Heart Failure

A
  • Set goals – requires self-management and monitoring
  • Monitor – weight, edema, respiratory symptoms
  • Lifestyle – restrict Na (fluids in end stage), engage in exercise, avoid tobacco & alcohol
  • Medication education – NO OTC NSAIDS
35
Q

Surgical Treatment of Heart Failure

A
  • Ventricular Assist Devices
    Implantable device that supports heart in maintaining flow, requires lifelong anticoagulant
  • Heart transplant
    Lifelong rejection meds, lifestyle modifications, consider comorbidities
36
Q
A

Nursing 3910 (12 decks)

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