Care of Clients with Problems in Oxygenation (Heart as a Pump)

From Sir Parial's PPT

Hypercoagulability

Injury

Stasis

What are the three components of the Virchow’s triad?

Myocardium

The thickest layer of the heart

Closure of the semilunar valves

Which event is responsible for the S2 heart sound?

Hemoptysis

Failure of the left side of the heart can lead to which of the following symptoms?

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A. Varicose veins

B. Ascites

C. Hemoptysis

D. Hepatomegaly

Infarction

A complete obstruction of blood flow in the coronary arteries could result in myocardial:

SA Node, 60-100

The ___ Node is the main pace-maker of the heart and fires spontaneously at ________ beats per minute.

Left Anterior Descending Artery

Most common site of atherosclerosis

Stroke volume

This refers to the amount of blood pumped by the heart every beat.

Afterload

Vascular resistance

Preload

Ventricular stretch/blood volume prior to systole

Contractility

Force of contraction (inotropic activity)

Vagus Nerve (stimulates parasympathetic NS)

Which cranial nerve does Valsalva Maneuver stimulate? Also the longest cranial nerve

True

True or False: Valsalva Maneuver slows down heart rate

increases

What happens to the preload and afterload during a general vasoconstriction?

decreases

What happens to the preload and afterload during a general vasodilation?

Contractility

Inotropic activity is also known as

Inotropes

Norepinephrine, dopamine, and dobutamine are examples of

Frank-Starling Law

What law indicates that the more stretch, the stronger the contraction until a physiological limit has been reached (like a balloon or rubber band)

RAAS (Renin-angiotensin-aldosterone system)

The system that regulates BP through hormones

Chest pain (PQRST)

Dyspnea

Dizziness, syncope

Edema

Fatigue

Palpitations

Cough, hemoptysis

Weight gain and skin changes

The common complaints related to CV disease (assessment)

A

The pt. is experiencing chest pain that is characterized with a squeezing feeling in the chest for about 15 minutes. Which of the ff is/are he/she most likely experiencing? Select all that apply

A. Stable Angina

B. Unstable Angina

C. Acute Coronary Syndrome

D. Myocardial Infarction

TRUE

TRUE or FALSE: When the pt. is experiencing angina that does not go away after administering three nitrates, you should rush them to the hospital.

Substernal

Anterior Chest

Vague

Exacerbated by (1) Exertion, (2) Extreme emotions, (3) Eating large meals, and (4) Extreme cold

Relieved by Rest \[or nitrates\]

Short Duration

What are the characteristics of anginal pain? (SAVERS)

FALSE: Patients with MI experience impending doom due to cerebral hypoxia

TRUE or FALSE: In Angina, there is a feeling of impending doom

Sedentary lifestyle

Age

Diet

Smoking

Alcoholism

Genes

Gender (Male = lifestyle; Female = after menopause)

Risk factors of CV disease

Hypertension

Diabetes

Hyperobesity

Hyperlipidemia

What are the four metabolic disorders?

Paroxysmal Nocturnal Dyspnea - blood backflow to the lungs

What can be implied from the number of pillow the patient is using while sleeping?

S3

Heart sound that is also known as ventricular gallop (pahabol)

S4

Heart sound that is also known as atrial gallop

Diaphragm

Which part of the stethoscope should you use to auscultate S1 and S2 sounds?

Bell

Which part of the stethoscope should you use to auscultate S3 and S4 sounds?

Murmurs

Swooshing sounds upon auscultation of the heart

Thrills

What do you call the palpable vibrations

Arterial

Arterial or Venous?: Insufficient organ perfusion

Venous (edema)

Arterial or Venous Insufficiency?: Heaviness

Arterial

Arterial or Venous Insufficiency?: Sharp stabbing pain

Venous (stasis)

Arterial or Venous Insufficiency?: Reddish color

Arterial

Arterial or Venous Insufficiency?: Pale skin

Arterial

Arterial or Venous Insufficiency?: Cold to touch

Venous

Arterial or Venous Insufficiency?: Warm to touch

Arterial

Arterial or Venous Insufficiency?: Non-healing wound

Venous

Arterial or Venous Insufficiency?: Edema

CK Total (?)

The most cardiac specific biomarker

Troponin

The most cardiac sensitive biomarker

What are the different diagnostic/laboratory examinations related to altered CV function?

What are the different coagulation studies?

True (triglycerides can be fat that is converted from sugar)

TRUE or FALSE: When you have high triglycerides, you are advised to reduce your rice consumption

True; The desirable level of cholesterol in the blood is

TRUE or FALSE: The first thing to assess in the lipid profile is the cholesterol levels

Echocardiography

Also known as the ultrasound of the heart (Ultrasound cardiography)

Ejection Fraction

Percent of EDV ejected with each heartbeat

Femoral artery

What artery is the access in cardiac catheterization?

False

TRUE or FALSE: 130-139 mmHg over 85-89 mmHg is considered Stage 1 HTN in International Society of Hypertension (2020)

Hypertension

What is the no. 1 risk factor of coronary artery disease?

Sclerosis

Plaque: Atheroma = Hardening: ________

True

True or False: All heart diseases lead to decreased cardiac output

Insufficient Tissue perfusion

Backward: Backflow = Forward: ___________________________

Injury

What component of the Virchow’s triad is present in Coronary Artery Disease?

Stasis

What component of the Virchow’s triad is present in Mitral Stenosis?

Backflow/Leaking mitral valve

Mitral Stenosis: Narrowing/Narrowed mitral valve = Mitral Regurgitation: ______________

False: insufficient filling or low preload

True or False: Increased heart rate means increased cardiac output

Shock

What happens if there is a lack of oxygenated blood supply to multiple organs?

Decreased Cardiac Output

Activity Intolerance

Give the two main nursing diagnoses regarding CV diseases

reduction of oxygen DEMAND / cardiac workload

promotion of OXYGEN supply

hemodynamic MONITORING (non-invasive)

prevention of COMPLICATIONS

REHABILITATION (cardiac rehab)

Management of Impaired Cardiac Function; Interventions (DOMCoRehab)

ACE Inhibitor (ACEI) → -PRIL (AcePril = credits to ley)

Angiotensin receptor blocker (ARB) → -SARTAN (e.g. Losartan)

Thiazide Diuretic (e.g. HCTZ or hydrochlorothiazide)

Calcium channel blocker (CCB) → -DIPINE (e.g. Amlodipine)

Initial Drugs of Choice for Hypertension based on JNC 8 hypertension guideline algorithm

Diuretic → to be taken in the morning to avoid nocturia

Alpha2 → causes vasodilation

Alpha1 → causes vasoconstriction

Beta blockers → -OLOL

ACE → -PRIL

ARBs → -SARTAN

Calcium channel blockers → -DIPINE

Give all medications for hypertension

\[D\]ecrease myocardial \[O\]xygen \[D\]emand and \[I\]ncrease \[O\]xygen \[S\]upply

What is the main goal/intervention for a patient with Angina? (DOD-IOS)

TRUE; Self-Care Deficit (Hygiene) r/t easy fatiguability

TRUE or FALSE: Self-care deficit (hygiene) is also a possible nursing problem in CV function alteration

Anticoagulants (Heparin/Warfarin)

Antiplatelets (Aspirin)

To prevent clot formation, what medication/s is/are administered in a pt. w/ angina?

Beta-adrenergic blocking agents (e.g. Propranolol)

Calcium channel blockers (e.g., Amlodipine)

To reduce cardiac workload, what medication/s is/are administered in a pt. w/ angina?

VS, respiratory distress

Pain

ECG

What should you monitor in a patient with angina?

Arrhythmia

What is the most common complication of myocardial infarction?

True

TRUE or FALSE: When the pt. has myocardial infarction, you should be ready to provide BLS any time.

1\. Ineffective myocardial tissue perfusion

2\. Risk for ineffective peripheral tissue perfusion

3\. Risk for fluid imbalance

4\. Death anxiety

What are the different nursing and collaborative problems regarding myocardial infarction?

True; To DECREASE myocardial oxygen demand and INCREASE oxygen supply

TRUE or FALSE: Angina and Myocardial infarction have the same main/goal and intervention.

Morphine Sulfate; It is a CNS depressant to treat SNS stimulation which increases both HR and BP

To manage the pain of a pt. w/ myocardial infarction, what medication/s is/are administered?

To avoid straining that causes vagal stimulation

Why is a pt. with myocardial infarction in complete bed rest (CBR) with no bathroom privileges (BP)?

Thrombolytic Therapy (E.g., Streptokinase, Urokinase)

What do you call the therapy used to manage myocardial infarction? (Hint: It dissolves the clot)

Balloon angioplasty \[with Stent to maintain patency)

What do you call the percutaneous coronary intervention to repair the artery associated with the MI?

NTG, Aspirin, Beta-blockers

What are the other medications administered to patients with MI?

It prevents constipation, because constipation can cause straining which leads to vagal stimulation

Why is lactulose administered to a patient with MI?

Assess indicators of CO, especially changes in level of consciousness.

What should you do first in patients with dysrhythmia?

1\. Decreased CO

2\. Anxiety

3\. Cardiac arrest, heart failure, thromboembolic events

Give nursing and collaborative problems secondary to dysrhythmias

Antiarrhythmics (e.g. Amiodarone)

What are the medications for patients with dysrhythmia?

False; it stops/resets the beating of the heart

(defib to ur heart: “amaccana bhie” \**sinapak**)

TRUE or FALSE: The defibrillator helps the heart to start beating

▪ Stenosis (narrowing)

▪ Regurgitation (backflow)

▪ Prolapse (displacement; can cause regurgitation)

What are the different valvular problems?

1. Surgery: Valvuloplasty, valve replacement


2. Management of heart failure

How do you manage valvular problems?

Mechanical and Tissue (mostly from a pig) valves

What are the two types of valve replacement?

Endocarditis

What do you call the inflammation of the inner lining of the heart due to bacterial infection?

• Antimicrobial therapy (penicillin, meropenem, vancomycin \[IV route\])

• Oral hygiene

• Prevention of URTI (untreated strep infections can cause endocarditis)

How do you manage endocarditis?

• Antimicrobials

• Anti-inflammatory (steroids)

• Proper position (tripod, orthopneic)

• Pericardiocentesis, if needed (can cause tamponade if heart is perforated)

How do you manage pericarditis?

Heart Failure

The end of all heart diseases

Slight Limitation

What is class II of the NYHA Functional classification of heart failure?

1\. Ineffective peripheral tissue perfusion (forward failure)

2\. Excess fluid volume (backward failure)

3\. Activity intolerance and fatigue

4\. Anxiety, Powerlessness, Noncompliance

5\. CP: Cardiogenic shock, edema, dysrhythmia, thromboembolism (stasis)

What are the different nursing and collaborative problems secondary to heart failure?

Decrease the workload of the heart by REDUCING PRELOAD AND AFTERLOAD

What is the main goal/intervention for a pt. with heart failure? (RPA)

1\. Prevention of exacerbations

2\. Stress management

3\. Fluid restrictions

4\. Medications: Diuretics\**, Digitalis* \*\*, ACE-I, ARB, Beta Blockers

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\*An example is furosemide (potassium-wasting)

increased CO → increased kidney perfusion → increased urine output → increased potassium wasting

THERE IS RISK FOR HYPOKALEMIA

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\*\* Only given once a day or once every other day

How do you primarily manage heart failure (how do you reduce the preload and afterload)?

Blood pressure (should not administer if 90/60 or below)

What should you assess before giving furosemide to the patient?

Apical pulse (should not be 60 or below)

What should you assess before giving digitalis/digoxin to a patient?

1\. Monitoring for symptoms of fluid overload

2\. Daily weight; I&O

3\. Diuretic therapy; timing of meds

4\. Fluid intake; fluid restriction

5\. Maintenance of sodium restriction

How do you intervene with fluid volume excess in heart failure?

1\. Bed rest for acute exacerbations

2\. Regular physical activity; 30-45 minutes daily

3\. Pacing of activities: Wait 2 hours after eating before physical activity

4\. Avoid activities in extremely hot, cold, or humid weather

5\. Modify activities to conserve energy.

6\. Positioning; elevation of HOB to facilitate breathing and rest, support of arms

How do you intervene with activity intolerance in heart failure?

Exercise counseling and training

Education for healthy-heart living

Counseling to reduce stress

What are done in cardiac rehabilitation?