nurs320 final - cardiac disorders

central perfusion

force of blood movement by CO (SV*HR, need good function, BP + vol)

decreased SV indicates

increased CO

increased SV indicates

decreases HR

peripheral perfusion

vol of blood to target tissue (impaired can lead to ischemia/necrosis/shock)

preload

vol in LV after diastole (ventric. relax)

good/high preload means

high SV (more stretch = good contract/perfuse)

afterload

resistance ventricles have to contract against (SVR, blood vol, vessel diam.)

increased afterload means

low SV (more resistance = plaque from smoke, etc.)

7 approaches to stay heart healthy

active (healthy weight, know abt choles./BS/diabetes), no smoke, diet, BP

patient history assessment - 6 P's of perfusion

(OLDCART) polar (cold), pale, pulseless (+1/weak, SOB/dizzy), paresthesia (numb/tingle), paralysis, pain

keep BP below

<140/90

cardiac meds

vasopressor, cardioglyco (dig, increase contract) diuretic, antidysrhyth, anticoag/PLT (prevent more clot), thrombolytic (breakdown clot), statin

peripheral arterial disorder (PAD)

poor perfuse + O2

PAD - atherosclerosis

(main cause) plaque/choles in arteries (can occur anywhere unknown, narrow + obstruct lumen, ulcer/rupture)

s/s of PAD

6 P (pt w CAD def has PAD, blood to central first)

periph perfusion testing - treadmill

pain in calf when walk (no O2 to muscle = intermittent claudication/PAD/CAD)

intermittent claudification

muscle pain (cramp/weak) in legs during exercise (relieved by rest)

periph perfusion testing - ultrasound

velocity of blood flow

periph perfusion testing - CT scan/MRI

see vessels (may need dye, know cautions!!)

periph perfusion testing - angiography

see vessel narrow diam. (may need dye)

periph perfusion testing - ankle brachial index (ABI)

check BP of lower/brachial

does lower or upper extremities have a higher BP

lower

altered peripheral perfusion s/s

intermittent claud, shiny/thin skin (tight), leg hair loss, low (absent) pulse, poor wound heal (+ulcer on toes, 6P)

dependant rubor

(red) feet dangle = red + perfuse (based on gravity)

elevation pallor

lift legs = white (blood cant reach heart against gravity, ONLY FOR PAD not PVD)

altered periph perfusion - pain at rest

in foot/toes by elevate (limbs)

how to position w altered periph perfuse

put affected area below heart, if edema = higher but below heart (isotonic/walk exercise for circulate)

peripheral artery bypass surgery

bypass vein to carry blood around occlude

how often to check pedal pulses

q15 mins (assess for 6 P, bedrest 18-24 hrs, pulse/cap refill, notify surgeon ASAP of ABN)

carotid artery disease

(similar to arterial) decrease blood to brain

carotid artery disease s/s

(neuro) change LOC, stroke

carotid artery disease caused by

(main cause, like PAD) atherosclerosis

carotid artery disease treatment

lower BP (carotid artery stent = assess VS + neuro)

carotid endarterectomy

scrape plaque in carotid (check CN status + meds post op)

PAD - raynaud's phenomenon

pallor/cold (vasoconstrict) in hands/feet

raynaud's phenomenon triggered by

(go to warm area) cold, nic, emotion (stress/anxious)

PAD - thromboangiitis obliterans/buerger's disease

(reccurrent) inflamm vaso-occlude = thrombi in upper/lower vessels

PAD - buerger's disease caused by

smoke (tobacco/marijuana) = inflamm/6 P/necrosis) = STOP

PAD - both raynaud's + buerger's is not caused by

atherosclerosis

how to help PAD

no tight clothes/cross legs, no stimulants (caffeine/chocolate + no smoke/stress, stay warm)

venous thrombosis

clot in vein from inflamm (stagnant/stasis = still blood)

superficial vein thrombosis (SVT)

(clot in superficial vein, benign) dont need dr help to break (put on anticoag)

deep vein thrombosis (DVT)

(illiac/femoral vein) decrease perfuse + travel (to diff organs)

DVT treatment

anticoag

high D-DImer indicates

(check for PE too!!) clot

venous thromboembolisms s/s

(asymptomatic) pain, swell (edema), tender, red (warm)

how to prevent venous thromboembolisms

(ambulate, fluids) elevate leg (NOT FOR PAD), compression socks (BAD when clot already present = travel), anticoag/PLT (subQ hep)

venous insufficiency disorders (PVD) s/s

ulcer (hard to heal) norm pulse (may need doppler but present), heavy legs (swell)

what is intermittent claudication typically seen in

PAD, not PVD

PVD treatment/care

no prolong sit/stand, elevate legs, wound therapy (diet/exercise)

BP is considered

(CO*SVR) amnt of force by blood against vessels

HTN is considered

>140/90 (pre = 120-139/80-89)

HTN diagnosis based on

>3 elevated readings (over wk or more), check both arms + use highest (120/130 = ok)

HTN emergency (crisis)

(hrs-days) >180/120 + acute organ dmg (MI, retinopathy, renal fail, etc.)

HTN urgency

(days-wks) >180/120, NO organ dmg

HTN treatment

(assess dmg organ) dash diet (healthy food, no smoke/alc/stress)

heart failure (HF)

impair contract/fill = low CO (HR*SV)

heart failure (HF) s/s

(fluid overload in heart) back flow, SOB

heart failure (HF) typically caused by

atherosclerosis (high afterload = pump hard thru plaque + work harder)

chronic HF indicates

lifestyle changes

does left or right fail first in HF

left (backflow then to lungs)

acute decompensated heart fail (ADHF/CHF exacerbate)

rapid backup to lungs = PE (pulm edema, increase in pulm venous pressure)

left side HF s/s

(resp s/s) cyanosis, crackle (cough, wheeze), high RR + HR (poor perfuse to brain/lungs)

right side HF commonly caused by

COPD (underlying resp disorder)

right side HF s/s

(by itself) distended JV (/organs), weight gain, edema, enlarge organs (splenomegaly)

how to help/manage HF

less salt/choles/fluids, weight self daily (no smoke/metabolic syndrome)

HF + weight gain

3 lbs in 2 days, 5 lbs in 1 wk (productive cough = retain fluid)

HF diagnosis - echo ejection fraction (EF)

(low = contract/CO problem) <55% (55% = norm)

HF diagnosis - elevated BNP indicates

(HF) heart stressed + release BNP to notify (when overstretch/bad contract)

meds for HF

diuretic, ACE/ARB, beta block, dig

coronary artery disease (CAD) - ischemia

lack of O2 to heart (angina from athersclerosis)

CAD - stable angina triggered by

(predictable, temporary) exertion (going up steps)

how to treat stable angina

PRN nitrate

CAD - unstable angina (acute coronary syndrome)

heart supply + demand issue (occur at rest, MI)

how to treat unstable angina

daily nitrate (patch/cardiac cath)

myocardial infarction (MI)

(emergency!!) no blood/O2 (cell death)

how to treat MI

(rapid response) 2L max O2 PRN, semi fowler, MONA (morph, O2, nitro SL, ASA CHEW, small amnt) (PCI or fibrinolytics if not PCI)

silent ischemia

no blood/O2 (to heart) w no s/s, seen on EKG

variant (prinzmetal) angina caused by

coronary artery spasm (occur at rest, tone not fat)

microvascular angina

bad function of small coronary arteries

CAD treatment

(ABCDEF), antiPLT(aspirin/NSAID)/coag/angina (nitrate)/HTN(ACE/ARB), beta block, cig smoke/choles (STOP), exercise (education, no overexert), flu vaccine

percutaneous transluminal coronary angioplasty (PCTA)

thru artery, open w balloon + place stent (for more blood/O2 flow)

infective endocarditis (IE)

valve infection of heart endothelial

infective endocarditis (IE) caused by

bacteria (valve deformity)

infective endocarditis (IE) treatment

IV antibiotics (PICC + before surgery), rest (replace valve PRN)

labs for infective endocarditis (IE)

echo, CRP, CBC

infective endocarditis (IE) s/s

(immunosuppressed) fever, anorexia, abd/back pain (arthralgia, decrease CO, high HR, low RR)

big sign of infective endocarditis (IE)

(vasc.) osler node (red spot, janeway leision, roth spot)

myocarditis

inflamm of myocardium (can possible resolve on its own or lead to HF, 3rd leading cause of death in young athletes)

myocarditis can be trigered by

virus (bacteria, parasite, fungi, auto immune = treat based on cause)

myocarditis s/s

angina, dysrhyth, SOB, syncope (fever/infection)

myocarditis diagnostic tests

CRP, troponin, EKG, echo, biopsy (more definitive, but only acute)

pericarditis

outer layer of heart fill w fluid (effusion) = peri friction rub (from heart compress/tamponade)

pericarditis can be caused by

(unknown) infection, autoimmune, MI

pericarditis s/s

friction rub, SOB, angina (worse when lay flat), JVD (low BP)

pericarditis diagnostic test

echo, CT, EKG, CRP (CXR)

pericarditis treatment

increase HOB to 45, antiinflamm/biotic (rest, no strenuous activity, sentesis to aspirate fluid in effusion)

cardiac rehab

slow + gradual (relax, increase MET>1 is min.)

cardiac rehab - exercise

increase CO/blood flow, decrease BP (+lipid)

static exercise

lift, heavy, strain (limited, increase HR + BP fast)