NSRG 250 QUIZ 6 TERMS

Acute pericarditis

• Inflammation or alteration of the pericardium, the membranous sac that encloses the heart; may be fibrous, serous, hemorrhagic, purulent, or neoplastic

• Nursing concepts

  • Commonly associated with:

    • Infective organisms (usually respiratory bacteria, viruses, fungi)

    • Post-myocardial infarction (MI) syndrome (Dressler syndrome)

    • Postpericariotomy syndrome

    • Acute exacerbations of systemic connective tissue disease

  • Substernal precordial pain radiating to left of neck, shoulder, or back

    • Classically grating and oppressive

    • aggravated by breathing (mainly inspiration), coughing and swallowing

    • Worse when supine, relieved when sitting upright and leaning forward

  • May have elevated WBC and usually a fever

  • Criteria

    • Pericardial chest pain

    • Presence of pericardial rub

    • New ST elevation in all ECG leads or PR-segment depression

    • New or worsening pericardial effusion

• Interventions

  • Use antibiotics and pericardial drainage for about 2-6 weeks

  • NSAIDs for pain

  • Sight upright and lean slightly forward

  • Colchicine can be used as adjunct to NSAIDS

Aortic stenosis

• Narrowing of the aortic valve orifice and obstruction of left ventricular outflow during systole

• Nursing concepts

  • Most common valve dysfunction in the U.S.

  • Disease of “wear and tear”

  • ↑afterload

  • ↓CO

  • Left ventricular strain & hypertrophy

  • Left ventricle does not empty completely

  • Pulmonary congestion later in the disease

  • Congenital bicuspid or unicuspid aortic valves are main causes

  • Can also occur with rheumatic disease of mitral valve

  • Atherosclerosis and degenerative calcification of aortic valve are major factors in older

  • Symptoms:

    • Dyspnea, angina, syncope on exertion

    • Marked fatigue, dehibilitation, peripheral cyanosis in later stages

    • Narrow pulse

    • Diamond-shaped systolic crescendo-descendo murmur

• Interventions

  • Heart-healthy lifestyle changes. Eat healthy, get regular exercise and stay active, and do not smoke.

  • Medicines to treat symptoms or reduce the risk of complications.

  • Surgery to fix or replace the valve

    • Balloon valvuloplasty.

    • Aortic valve replacement.

    • Transcatheter aortic valve replacement (TAVR).

    • Aortic valve repair.

  • Medications

    • Lower blood pressure.

    • Prevent irregular heartbeats.

    • Remove excess fluid from the body to reduce the strain on the heart.

Infective endocarditis

• A microbacterial infection (EX: viruses, bacteria, fungi) involving the endocardium

• Nursing concepts

  • Acute

    • Usually caused by virulent organisms

    • Most likely to follow open-heart surgery or infection elsewhere in body

  • Subacute (more common)

    • Usually caused by low-virulence organisms with limited ability to infect other organs

    • May exist for long period in inactive state

  • Most common infective organism is Streptococcus viridian or Staphylococcus aureus

  • Primarily in patients with injection drug use and history of valve replacements, systemic alterations in immunity, or structural cardiac defect

• Interventions

  • Antimicrobials (Penicillins, cephalosporins)

  • IV therapy

  • Anticoagulants to prevent thrombus formation on prosthetic valve

  • Rest balanced with activity

  • supportive therapy for Heart Failure

    • Assess for signs (rapid pulse, fatigue, cough, and dyspnea)

  • Aseptic technique

  • Surgical means

    • Removing infected valve

    • Repair/remove congenital shunts

    • repair injured valves and chordae tendineae

    • Drain abscesses in heart

Mitral regurgitation/prolapse

• R - Inability of the mitral valve to close completely during systole, which allows the backflow of blood into the left atrium when the ventricle contracts

• P - Dysfunction of the mitral valve that occurs because the valvular leaflets enlarge an prolapse into the left atrium during systole

• Nursing concepts

  • R

    • Primary causes:

      • Mitral valve prolapse, rheumatic heart disease, infective endocarditis, myocardial infarction

      • Connective tissue diseases like marfan syndrome and dilated cardiomyopathy

    • Secondary causes

      • Ischemic and nonischmeic heart diseases

      • Rheumaric heart disease

    • Progresses slowly, may be symptom free for decades

    • Symptoms begin when left ventricle fails to respond due to chronic blood volume overload

    • Symptoms

      • Fatigue, chronic weakness (due to low CO2), dypsnea on exertion, orthopnea, anxiety, atypical chest pain, palpitations

    • Normal BP, atrial fibrilation, or respirations changes may be present

  • P

    • Usually benign, may progress to R

    • Associated with Marfan syndrome and other congenital cardiac defects

    • Asymptomatic

      • May have chest pain (atypical, sharp pain to left chest), palpitations, exercise intolerance

      • Dizziness, syncope, palpitations

    • Normal HR and BP

      • Midsystolic click and late systolic murmur may be heard

• Interventions

  • Healthy lifestyle changes.

  • Regular health checkups.

  • Medicines to treat symptoms and prevent complications, such as blood clots.

  • Surgery to repair or replace the mitral valve.

  • Diuretics

  • Anticoagulants

  • Blood pressure meds

  • mitral valve repair and mitral valve replacement

  • Annuloplasty, Valvuloplasty, Mitral valve clip

Pericardiocentesis

• Withdrawal of pericardial fluid through a catheter inserted into the pericardial space to relieve the pressure on the heart

• Nursing concepts

  • Insert 8 inch, 16/18 gauge pericardial needle into pericardial space

  • Once needle is in, catheter is inserted and fluid is withdrawn

  • Drain may be placed temporarily

  • Monitor pulmonary artery and right atrial pressures during procedure

• Interventions

  • client will need close monitoring for approximately 48 hours.

  • Continuous ECG and frequent monitoring of VS will be essential to ensure improvement of cardiac output and perfusion and maintenance of hemodynamic stability.

Abdominal aortic aneurysm

• an enlargement or bulge in the part of your aorta that extends through your belly or abdomen

• Nursing concepts

  • Sometimes asymptomatic

  • Symptoms:

    • Gnawing pain with abdominal, flank, or back pain

    • Pulsation in upper abdomen

    • Detectable = at least 5 cm in diameter

  • Potential complication = Rupture: A Medical Emergency

    • Critical illness – at risk for hypovolemic shock caused by hemorrhage

• Interventions

  • Antihypertensive drugs

  • Frequent ultrasounds and CT scans

  • Resection or repair (aneurysmectomy)

  • Endovascular stent grafts

Acute arterial occlusion

• Sudden blockage of an artery, typically in the lower exremity, in the patient with chronic peripheral arterial disease

• Nursing concepts

  • Severe pain below level of occlusion even during rest

  • Extremity is cool/cold, pulseless, and molted

  • Small areas on toes may be blackened or gangrenous due to low perfusion

  • Six P’s of ischemia:

    • Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermy

• Interventions

  • Anticoagulant therapy with unfractioned heparin

  • Angiography

  • Surgical thrombectomy or embolectomy with local anesthesia

  • Cathether directed intraarterial thrombolytic therapy with fibrinolytics (TPA)

Arteriosclerosis

• Thickening or hardening of the arterial wall, often associated with aging

• Nursing concepts

  • You may have no symptoms for a long time until the hardening of your arteries leads to complications.

  • Raises your risk for a wide range of cardiovascular diseases

  • Can affect:

    • Aorta. Coronary arteries. Carotid arteries. Femoral arteries. Iliac arteries.

  • Symptoms:

    • Burning or aching pain in your feet at rest. Changes in how often you pee. Chest pain or discomfort. Dizziness. Dry, itchy or numb skin. Fatigue. Heart palpitations. Leg pain (intermittent claudication). Nausea or vomiting. Shortness of breath. Slurred speech or trouble communicating. Sores on your feet. Swelling (edema). Vision loss in one eye. Weakness on one side of your body.

  • Risk factors:

    • Chronic kidney disease. High blood pressure. High cholesterol. Increasing age. Lack of physical activity. Metabolic syndrome. Tobacco use. Type 2 diabetes.

• Interventions

  • Do not smoke or use tobacco.

  • Eat nutritious foods.

  • Get regular exercise and keep an active lifestyle.

  • Keep a healthy weight.

  • Control blood pressure, blood sugar and cholesterol.

Atherosclerosis

• Type of arteriosclerosis that involves the formation of plaque within the arterial wall; the leading contributor to coronary artery and cerebrovascular disease.

• Nursing concepts

  • Progresses over time

  • Rate of progression related to risk factors

    • Family history

    • Lifestyle factors

      • Diet, Sedentary lifestyle, Obesity, Smoking

    • Disease factors

      • Hypertension, Diabetes, Homocysteine and lipid levels

    • Stress 

    • Age

• Interventions

  • Eat vegetables, fruit, whole grains, low-fat dairy products, no skin poultry, fish, legumes, nontropical vegetable oils, nuts

  • Limit sweets, sugar-sweetned beverages, red meat

  • Diet includes 5-6% of calories from saturated fat and limit trans fat

  • Physical activity 3-4 times a day, 40 minutes on average, moderate to vigorous activity

  • Cholesterol lowering agents

    • HMG-CoA reductase inhibitors - lovastin, simvastin, pitavastin

  • Lipid-lowering agents - ezetimibe, Vytorin, Amlodipine and atorvastin with Caduet

  • PCSK9 inhibitors - alirocumab and evolovumab

  • Nicotinic acid or niacin

  • Lovaza

Intermittent claudication

• Characteristic leg pain experienced by patients with chronic peripheral arterial disease

• Nursing concepts

  • Exercised-induced leg pain

  • Most common symptom of PAD

  • Pain location depends on arterial tree

  • Pain is reproducible

  • Can remain stable for years

• Interventions

  • Walk regularly.

  • Reach and maintain a weight that’s healthy for you.

  • Eat healthy foods.

  • Quit using tobacco products.

  • Take your medications.

  • Manage stress, anxiety and mental health

Chronic stable angina

• Type of angina characterized by chest discomfort that occurs with moderate to prolonged exertion and in a pattern that is familiar to the patient

• Nursing concepts

  • Frequency, duration, and intensity of symptoms remain same over several months

  • results in only slightly limitation of activity

  • usually associated with fixed atherosclerotic plaqie

• Interventions

  • Nitroglycerin

  • rest

  • Drug therapy

  • Rarely needs aggressive treatment

Infarction

• Necrosis or cell death

• Nursing concepts

  • Occurs when severe ischemia is prolonged

• Interventions

  • Percutaneous coronary intervention (PCI):

  • Coronary artery bypass grafting (CABG):

  • Fibrinolytic therapy:

  • ACE inhibitors or ARBs (Lisinopril, Losartan)

  • Antiarrhythmics 

  • Anticoagulants (Warfarin, Heparin)

  • Aspirin and a P2Y12 inhibitor (dual antiplatelet therapy

  • Beta-blockers  (Metorprolol, Propanolol)

  • Nitroglycerin 

  • Statins (atrorvastin, simvastatin)

Ischemia

• Blockage of blood flow through a blood vessel, resulting in a lack of oxygen

• Nursing concepts

  • Occurs when insufficient oxygen is supplied to meet requirements of myocardium

• Interventions

  • Aspirin.

  • Nitrates.

  • Beta blockers.

  • Calcium channel blockers.

  • Cholesterol-lowering medications.

  • Angiotensin-converting enzyme (ACE) inhibitors.

  • Ranolazine (Ranexa).

  • Angioplasty and stenting.

  • Coronary artery bypass surgery

  • Enhanced external counterpulsation.

  • Quit smoking.

  • Manage underlying health conditions.

  • Eat a healthy diet.

  • Exercise.

  • Maintain a healthy weight.

  • Decrease stress.

Percutaneous coronary intervention (PCI)

• Nonsurgical method of improving arterial flow by opening the vessel lumen. A balloon is inserted in the coronary artery and inflated to open blood vessels; procedure may include insertion of a coronary stent

• Nursing concepts

  • should be done within 90 minutes of acute STEMI diagnosis

  • Excellent return of blood flow through coronary artery and can decrease extent of myocardial damage

  • Can reduce frequency and severity of discomfort in patients with angina

  • Can lead to CABG surgery

  • Done in cardiac catheterization laboratory and combines clot retrieval, coronary angioplasty, and stent placement

  • Steps

    • Balloon tipped catheter is positioned in artery

    • Uninflated balloon is centered in obstruction

    • Balloon is inflated, flattening plaque against cell wall

    • Balloon is removed, artery left unoccluded

• Interventions

  • May receive boluses of IV heparin or continous infusion of bivalirudin

  • Must take dual antiplatelet therapy

    • Aspirin and platelet inhibitor

  • Long-term nitrate and beta blocker

  • ACEI or ARB may be added

  • May get potassium supplements if hypokalemic

Unstable angina

• Chest pain or discomfort that occurs at rest or with exertion and causes severe activity limitation

• Nursing concepts

  • Indicated by increase in number of attacks and in intensity of pressure

  • Pressure may last longer than 15 minutes or be poorly relieved by rest of nitroglycerin

  • Can include: new-onset angina, vasospastic angina, preinfarction angina

  • May present with ST changes on 12-lead ECG but don’t have troponin level changes

  • Ischemia is present but not severe to cause damage

• Interventions

  • Nitroglycerin to help with chest pain and improve blood flow.

  • Blood thinners like aspirin or clopidogrel to protect against blood clots.

  • Beta-blockers to lessen your heart’s workload. (Metoprolol, propanolol)

  • Cholesterol-lowering medicine. (Statins)

  • High blood pressure medicine. (ACE inhibitors, ARBs)

  • Medicine to help regulate your heart rhythm.

  • Angioplasty with stent implantation.

  • Heart bypass surgery.

Vasospastic angina

• Angina caused by coronary artery vasospasm that often occurs at rest or during the early morning hours; also called variant or Prinzmetal angina

• Nursing concepts

  • temporarily reduce blood flow to your heart muscle, leading to the pain that you feel.

  • These episodes typically occur overnight when you’re asleep, but they may happen at any time.

  • Diagnosing may be difficult.

  • can progress to a heart attack if your heart goes too long without blood flow.

  • You may also have other symptoms, like shortness of breath, nausea or profuse sweating

  • Caused by Coronary artery spasms

• Interventions

  • Calcium channel blockers (Amplidopine, diltiazem)

  • Long-acting nitrates (Isosorbide mononitrate)

  • Nitroglycerin

  • Statins

  • Quitting smoking

  • Avoiding addictive substances

  • Eating heart-healthy foods

  • Moving around more

Ventricular remodeling

• After a myocardial infarction, permanent changes in size and shape of left ventricle due to scar tissue; such remodeling can decrease left ventricular function and cause heart failure

• Nursing concepts

  • Scarred tissue does not contract or conduct electrically

    • thus area is often cause of chronic ventricular dysrhytmias surrounding infarcted zone

• Interventions

  • ACE Inhibitors & ARBs:

  • Beta-Blockers:

  • Mineralocorticoid Receptor Antagonists (MRAs):

  • ARNIs & SGLT2 Inhibitors

  • Left Ventricular Assist Devices (LVADs):

  • Cardiac Resynchronization Therapy (CRT):

  • Transcatheter Ventricular Restoration Systems: