Medical-Surgical Nursing: Care of the Cardiovascular Patient and CAD

Coronary Artery Disease

atherosclerosis of the coronary arteries that reduces the blood supply to the heart muscle

Modifiable Risks of CAD

Cholesterol, HTN, Diabetes, Obesity, Smoking

CAD Manifestations

angina, diaphoresis (cool sweat), fatigue

Stable Angina

chest pain that occurs when a person is active or under severe stress

Unstable Angina

chest pain that occurs while a person is at rest and not exerting himself

Prinzmetals Angina

coronary artery vasospasm

Chest Pain unrelieved by nitroglycerin is

indicative of a MI

Surgical Management of CAD

PTCA

CABG

PTCA

balloon angioplasty

How long from when a patient enters the ER do you have to do a PTCA?

60 Minutes

Where do they insert stents?

In arm or leg to move to heart.

CABG

coronary artery bypass grafting

Ateplase (tPA)

thrombolytic used to destroy clot

How long from when a patient enters the ER do you have to do use ateplase?

Less then 30 minutes.

Chest pain is ALWAYS

cardiac until proven otherwise.

Men nonspecific symptoms

Left Arm, Left Jaw Pain, Sweat

Women nonspecific symptoms

Back pain, Nausea, fatigue

CAD Goal

Patient to have resolved chest pain without cardiac tissue loss and function.

What pain level is allowed for chest pain1?

0/10

Nursing Diagnosis of CAD

decreased tissue perfusion

CAD requires blood pressure every

5 minutes.

While is BP required Q5 with CAD

If chest pain is not resolved, tissue is dying causing less cardiac output. Meaning BP will drop.

What will you see on EKG with CAD?

ST Elevation

Physical Assessment of CAD

Pale, Sweaty, N/V, SOB, CP

Drugs that can cause CAD

Cocaine and Amphetamines

Lab values to check for CAD

Electrolytes, Cardiac enzymes

Cardiac Enzymes

Troponin and CKMB

ST Elevation

Nursing Interventions: CAD - Apply oxygen IF

sats are less then 90

Nursing Interventions: CAD - Obtain

EKG

Nursing Interventions: CAD - Administer

medications as ordered.

Nursing Interventions: CAD - Medications

M - morphine 3rd

O - Oxygen 1st ( <90%)

N - Nitroglycerin 2nd

A - Aspirin 325mg

When do you hold Nitroglycerin

Systolic BP <90

Nursing Interventions: Post PCI - Cardiac ____

Cath Care

Nursing Interventions: Post PCI -Nu Report and treat

Chest Pain RIGHT AWAY

What may chest pain indicate post PCI

Re-occlusion

Nursing Interventions: Post PCI - Administer

Anticoagulants and Antiplatelets

Why do we admin Anticoagulants post pci?

Body will try to wall off new stent

Nursing Interventions: Post PCI - Maintain

Fluids to wash out dye that can be intra-renal toxic

Nursing Interventions: Post PCI - Assess for

hematoma

Nursing Interventions: CAD Medications

aspirin, statins, Beta Blocker, Ace Inhibitors

Statins

drugs used to lower cholesterol in the bloodstream

When to call emergency services with CAD

- Chest pain > 5 minutes

- Not relieved by rest

- Not relived by 1 nitroglycerin tablet

- New or Worsening Angina

Ejection Fraction of a Normal Heart

50-70%

Ejection Fraction of a Systolic Dysfunction

<45%

Ejection Fraction of a Diastolic Dysfunction

may be normal or high

Systolic Dysfunction

decreased contractility

Diastolic Dysfunction

Impaired filling of the heart during diastole.

Pathophysiology of Heart Failure

- Myocardial dysfunction

- Inability of the Heart to meet needs of the body

Left Sided heart failure S/S

- SOB

- Fatigue

- Orthopnea

- Crackles

- Tachycardia

- Murmurs

- Pulmonary Edema

right sided heart failure

- JVD

- Edema in abdomen and legs

- Hepatomegaly

- S3 and S4 Murmur

- Hypotension

Preload

volume of blood in ventricles at end of diastole

Drugs that effect preload

Diuretics

Contractatility

Strength of the heart

Drugs that improve contractability

Digoxin

Afterload

The force or resistance against which the heart pumps.

Drugs that improve afterload.

ACE inhibitors and ARBS

Medical Diagnosis of Heart Failure

- Chest X-Ray

- ECG

- Echocardiogram

- Laboratory testing

What lab test measures heart failure

High BNP

BNP

brain natriuretic peptide

What does a high BNP mean?

Stressed Heart Muscle

What does a high BNP Cause

Diuresis and Vasodilation

Surgical Treatment of Heart Failure

AICD and LVAD

Internal Cardiac Defibrillator (AICD)

Recognition and Shocking of Patient on Own

LVAD

left ventricle assist device

What will patient not have with LVAD

Pulse

Heart Failure ultimate Treatment

transplant

Self Symptom Management of HF

- Daily Weight

- Increasing Exertional Dyspnea

Complications of HF

- Pulmonary Edema

- Renal Failure

HF Nursing Goal

The pt will have reduced exacerbations, visits to ER and hospitalizations due to HF

HF Nursing Diagnosis

Impaired Oxygenation, Decreased Cardiac Output, ineffective peripheral perfusion

HF Fluid and Sodium Restriction

1-2L/Day and 2g Na

Worrisome Weight Gain for HF

2lbs in 24 or 5lbs in 7

What is released during an MI

Troponin

What is released during HF

BNP