T2 cardiac and vascular disorders

ch 38 - 41

Acute heart failure

Sudden onset or worsening of heart failure

Decompensated heart failure

Pre-exsisting heart condition experiencing sudden severe worsening of condition

Left sided hf signs and sympt

Pulmonary congestion

SOB during exertion

Upright respiration position

Coughing at night

Heart palpitations

Fatigue and tiredness

Increased HR

Dyspnea

Right sided HF signs and sympt

Loss of appetite

Lower leg edema

Weight gain

Swelling

Distended jugular veins

Ascites

Hepatomegaly (liver enlargement)

Worsening HF signs and sympt

SOB

Easily fatigued

Gravity dependent edema

Pt edu to prevent exacerbation

Low sodium diet

Regular exercise

Cease smoking

Cardiac meds

Diuretics - loop, thiazide

Antigoagulants

Antidysrhythmic

Beta blockers

Infective endocarditis cause

Bacteria - strep most common

Virus

Fungi

Infective endocarditis risk factors

Aging

Prosthetic valve

Hemodialysis

Intravascular devices

IV drug use

Rheumatic heart disease

Infecfive endocarditis signs and sympt

Fever

Chills

Weakness

Malaise

Fatigue

Anorexia

Arthralgias

Myalgias

Back pain - abd discomfort

Heart failure

Weight loss

H/a

Clubbing in subacute infections

Oslers nodes

Janeways lesions

Roths spots

Infective endocarditis interventions

Blood culture over 1 hr from 3 sites

Labs - CBC, c-reactive protien, erthrocyte sedimentation rate

Pericarditis signs and sympt

Progressive, severe, sharp pleuritic chest pain

May radiate to shoulder, neck upper back

Worse w/inspiration and lying supine

Relieved by sitting and learning forward

Pericardial friction rub

Pericardial friction rub

High pitched, scratchy sounds

Best heard @ apex or LL sternal border w/pt upright and leaning forward

May have fever, dyspnea - rapid shallow breaths

Have pt hold breath to differentiate pleural causes

Pericarditis diagnostic tests

Echocardiam

ECG, WBC

CRP, ESR

analyze pericardial fluid or tissue

Pericarditis interventions

Bed rest w/HOB at least 45 degrees

Antibiotics, NSAIDs, anti-anxiety meds

Upright sitting and leaning forward

Cardiac tamponade causes

Acute pericarditis

Trauma

MI

aortic dissection

Cardiac tamponade signs and sympt

Becks triad - hypoTN, JVD, muffled heart sounds

Tachycardia

SOB

Narrowed pulse pressure

Cardiac tamponade assessment

Increased vol in space - compresses atria, vena cava, plum veins

Decreased RV filling in diastole - decreased stroke vol and cardiac output

RV collapse - cardiac arrest

Rheumatic fever causes

Complication 2-3 wks after a group A strep

Abnormal immune response to bacterial antigens

Rheumatic fever pt teahcing

Rest

Anti inflam meds

Mechanical (artifical) valve replacement

Last longer

Risk of thromboembolism

Long term anticoagulation

Biologic (tissue) valve replacement

Via cow, pig, human

No anticoagulation or immunosuppression required

Valve replacement interventions

Monitor VS

Infection control

Monitor I & O

assess surgical site

valve replacement pt edu

avoid strenuous activities (weight lifting, etc) for 3 months

try to talk everyday

rest

cardiac cardiomyopathies

monitor I & O

daily weights

intermittent claudication

leg pain / cramps while walking

d/t lactic acid build up

resting <10 min should resolve problem

peripheral artery disease symptoms

diminished / absent pulses

leg pain while walking

dependent rubor, elevation pallor

paresthesia in feet

thin, shiny, taut skin

lower leg hair loss

wound infections, gangrene

delayed healing of ulcers

peripheral artery disease risk factors

tobacco use

atherosclerosis

diabetes

HTN

high cholesterol

> 60 yrs

6 P’s of acute aterual ischemia

Paresthesia

pain

pulselessness

pallor

poor body temp / perishing cold / poikothermia (cool to touch)

paralysis

VTE symp

unilateral edema

pain

paresthesia

warmth

redness

tenderness

may have fever

VTE risks

obesity

pregnancy

long trips

prolonged surgeries

immobility

VTE prevention

reduce risk factors

no pillows behind knees

early ambulation, ROM

position change q2hrs

compression stockings, SCDs

low dose anticoagulation

VTE interventions / pt

elastic compression socks

IV heparin for at least 5 days - bridge to oral warfarin

pain med

bro i have VTE so im gonna massage my legs, use an SCD and cross my legs

NO

aortic aneurysms signs and smpt

thoracic aorta aneurysm (TAA)

ascending aorta / aortic arch

abdominal aortic aneurysm (AAA)

thoracic aorta aneurysm (TAA)

deep diffuse chest pain

may extend to interscapular area

ascending aorta / aortic arch

angina, transient ischemic attacks

coughing, SOB, hoarseness, dysphagia

abdominal aortic aneurysm (AAA)

pulsatile mass in periumbilical area slightly left of midline

bruit auscultated over aneurysm

may mimic pain associated w/ abdominal or back pain disorders

aortic aneurysms risk

age

men more common

HTN

CAD

family hx

tobacco use

high cholesterol

lower extremity PAD

previous stroke

obesity

aortic aneurysm diagnosis

x - ray

ECG - to rule out MI

echocardiography

unltasonography

CT scan or MRI

angiography

aortic dissection type A sympt

abrupt onset of severe anterior chest pain or back pain

aortic dissection type B sympt

back, abdomen, or leg pain

aortic dissection gen sympt

sharp, tearing, ripping, stabbing, worst ever pain

venous insufficiency sympt

leathery brown skin

prolonged edema

statis dermatitis

itching

painful ulcers

slow wound healing

venous insufficiency

dull, achy, pain

lower leg edema

pulse present

drainage, sores w/ irregular borders

yellow slough / ruddy skin

sores located @ ankles

PAD

intermittent claudication pain

no edema, pulse (or weak), drainage

round smooth sores

black eschar

sores located @ toes & feet

venous insufficiency

tight blood glucose control

avoid prolonged standing

compression socks

no crossing legs or restrictive clothing

weight loss

elevate legs

ways to reduce raynauds phenomenon occurances

avoid temp extremes

no tobacco or vasoconstrictor drugs

void caffeine