NRSG 2300 unit 9

perfusion A

atria

receives blood returning from body and lungs

Ventricles of heart

pumps blood to the body and lungs

Septum of heart

separates right and the left side of the heart

Cardiac output

the amount of blood that is ejected from one ventricle in L/min

Cardiac output equation

stroke volume X heart rate

Stroke volume

the volume of blood that is ejected by one ventricle per heartbeat

What 3 factors determine stroke volume

preload, after load, and contractility

afterload

the RESISTANCE OR PRESSURE that left a ventricle that is needed to help eject blood out and for it to circulate and contract

contractility

the force of the heart that the myocardium generates during a contraction (the force)

Atherosclerosis

a narrowing or occlusion of the arteries that can lead to CAD and stable and unstable angina

Coronary Artery Disease

occurs when there is a build up of plaque in the coronary arteries

Atherosclerosis can lead to

decreased oxygenation and perfusion to the myocardium and stable and unstable angina

Angina

chest pain

Stable angina

when you feel chest pain after working out or moving around. Decreased oxygen delivery to the heart muscle. Pain occurs when the heart needs more oxygen than normal. Manifestations last less than 15 minutes

Unstable angina

when you feel chest pain by not doing anything or moving (like sitting on a couch). when an artery is significantly narrows and the heart is ischemic

Variant angina

chest pain due to coronary artery spasm and occurs during periods of rest

Stable angina is relieved by what

rest or nitroglycerin

Treatment of angina

can be meds like nitroglycerin or rest

CAD risk factors

unhealthy eating, not working out, family history, obesity, sex, lack of sleep, diabetes, hypertension, race, lipid levels, smoking, stress, age, homocysteine levels

CAD risk factors that are chronic diseases

hyperlipidemia, thyroid disease, depression, joint pain, BMI 30 or greater, gout, cancer, osteoarthritis

CAD presents as

can be asymptomatic at first, angina, tightness, fullness, pressure in midsternal area, pain radiating from left arm, neck, jaw, or back. Pain from activity aka stable angina or from rest aka unstable angina

CAD manifestations appear when

appear when there is a decreased blood flow and oxygen to the heart

CAD in females, older adults, and diabetics presents as

may not have chest pain (mainly pain in left arm, neck, jaw, or back)

CAD complication

myocardial infarction aka heart attack

Nitroglycerin

a vasodilator that prevents coronary artery vasospasm and reduces preload and after load to help decrease myocardial oxygen demand. 

What is nitroglycerin used to treat

angina and control bp

What to monitor for with nitroglycerin

orthostatic hypotension and bp, change positions slowly, headache is COMMON with side effects

How to take nitroglycerin

place pill under tongue and let is dissolve

What to do if pain is unrelieved with nitroglycerin

if not relieved in 5 minutes, call 911 or go to ED. Can take 3 pills within 15 minutes (5 minute intervals)

Angina or MI med management includes

MONA (morphine (for pain), oxygen, nitrate, and aspirin(to help with preventing vasoconstriction and has antiplatelet effects))

How to diagnose for CAD

CARDIAC CATHERTERS, stress tests, x-ray, ECG

CAD lab studies

cholesterol, homocysteine, C-reactive protein, and cardiac enzyme

Role of the nurse with CAD

get a complete history and physical, go over lifestyle habits, occupation (stress, exposure to toxins, irregular shifts and hours), other health conditions, family history, meds, SDofH, weight, diet, smoking, hypertension, hyperlipidemia, diabetes

Procedures for CAD

angioplasty (balloon), coronary artery bypass graft

Meds to take for CAD

ACE, ARBs, beta blockers, calcium channel blockers, nitrates, statins, non-statins, anticoagulants, antiplatelets

Non-pharm changes for CAD

no smoking, heart healthy diet, maintain healthy weight, physical activity, 7-9 hours of sleep

Heart failure is when

the heart is not able to meet the needs and demands of the systemic circulatory system and pump efficently. Ventricles don’t fill properly. Blood is not ejected into the systemic circulatory system properly

New York heart association scale

determines from scale of 1-4 of the s/s of heart disease based on physical activity. 1 is not limitation of physical activity and can do physical activity with no s/s. 4 is you can’t do physical activity or do more exercise without discomfort and has s/s when resting. 

American college of cardiology and AHA staging HF stages

stages a-d (1-4) based on if you have s/s of HF and to what degree. Stage A is that you are at risk for HF due don’t have s/s of it. Stage D is that you have Heart Failure and are hospitalized and can die from it

What is ejection fraction

the amount of blood that is pumped out of the heart / amount of blood in the heart chamber

Ejection fraction helps determine

how well the heart is pumping blood to the body

Normal ejection fraction

50-70% pumped out during each contraction

Borderline ejection fraction

41-49% pumped out during each contraction

Reduced ejection fraction

less than 40% is pumped out during contractions (BAD)

Heart failure causes

main is PULMONARY EDEMA, systemic HTN, myocardial infarction, pulmonary hypertension, dysrhythmias, valvular heart disease, pericarditis, cardiomyopathy 

Pulmonary edema in HF

a severe and life threatening accumulation of fluid in the alveoli and interstitial spaces of the lung and can result in HEART FAILURE

HF risk factors

family history of heart disease, chronic pulmonary disease, CAD, HTN, chronic infection, diabetes, obesity, metabolic disease, alcohol abuse, cardiotoxic agents, ethnicity

cardiomyopathy

blood circulation to the lungs is IMPAIRED when the cardiac pump is compromised and leads to HF

Cardiomyopathy risk factors

infection or inflammation of the heart muscle, CAD, various cancer treatments, prolonged alcohol use, heredity

Types of cardiomyopathy

dilated, hypertrophic, restrictive

Most common form of cardomyopathy

dilated

Dilated cardiomyopathy

very dilated ventricles which increases ventricle volume but decreases EF. Ventricles enlarges and fill up with a ton of blood but not a lot leaves. 

Hypertrophic cardiomyopathy

increased heart muscle size and mass which reduces the ventricle size

Restrictive cardiomyopathy

rigid and stiff ventricular walls that impair filling and ventricular stretch. They are stiff so they have a hard time getting blood in and out

cardiomyopathy manifestations

fatigue, weakness, HF, angina, dysrhythmias aka heart block, s3 gallop, cardiomegaly aka enlarged heart

Left sided HF s/s

pulmonary congestion, dyspnea, SOB, s3 heart sound, tachycardia, nocturnal dyspnea, orthopnea, fatigue, frothy sputum/blood, nocturne, altered mental status

Right sided HF s/s

JVD, SOB, fatigue, weakness, nausea, anorexia, weight gain, ascites, peripheral edema, enlarged liver and spleen, abdominal distention

Biventricular HF

HF on both the left and right sides

HF diagnostic tests

blood tests (BNP), cardiac catheter, ECG, chest x-ray, egg, tee, cardiac enzymes, electrolytes

Role of nurse with HF

assess clients ability to do ADLs, administer O2, med safety, maintain ordered diet restriction (low fluids and low sodium), monitor daily weights, I/O, VS, SOB, encourage bedrest until pt is stable, give emotional support, position pt to max ventilation aka high-fowlers

Non-pharm HF treatments

elevate head of bed to high-fowlers, anxiety relieving techniques, no smoking, weight reduction, use caffeine and alcohol in moderation, heart-healthy diet, physical activity, monitor fluid intake

Meds for HF

ACE, ARBs, calcium channel blockers, inotropic, beta blockers, vasodilators, diuretics

Surgical interventions of HF

cardiac catheter, implant a cardioverter defibrillator, pacemaker, VAS, heart transplant

HF client education

effective breathing techniques, sleep on left side can cause discomfort and breathing issues, understand meds, continue to take meds, report manifestations, reduce modifiable RF, stay on low-sodium diet, restrict fluids, measure weight daily, notify doc if you gain 1-2lbs in a day or 3lbs in a week. Report swelling of feet or ankles or SOB

HF complications

acute pulmonary edema and cariogenic shock

Acute pulmonary edema w HF

a LIFE-THREATENING EMERGENCY. S/s are anxiety, tachycardia, acute respiratory distress, dyspnea at rest, change in level of consciousness, ascending fluid level w lungs (crackles, cough, etc). Effective intervention results in (diuresis, respiratory distress, improved lung sounds, oxygenation)

PROMPT nursing actions w pulmonary edema w HF

• Postion client in H-F

• Stay with client

• Notify provider

• Give oxygen 

• IV morphine

• IV admin of loop diuretics and meds to help with CO

Cardiogenic shock with HF

a serious complication of pump failure. S/s: tachycardia, htn, inadequate urinary output, altered level of consciousness, respiratory distress (crackles and tachypnea), cool and clammy skin, chest pain

PROMPT nursing actions w cardiogenic shock w HF

• Monitor breath sounds for crackles or wheezing

• Monitor heart sounds

• Admin oxygen and morphine and diuretics to help decrease preload

• Administer IC vasopressors or + ionotrophics to increase CO

Congenital heart defects maternal risk factors

infection, alcohol or substance use with pregnancy, diabetes

Congenital heart defects genetic risk factors

family history, syndromes, presence of other abnormalities

Congenital heart defects that are INCREASED PULMONARY BLOOD FLOW and from L to R

• Atrial Septal Defect (ASD)

• Ventricular septal defect (VSD)

• Patent ductus arteriosus (PDA)

Congenital heart defects that are DECREASED PULMONARY BLOOD FLOW and form R to L

Tetralogy of Fallot

Obstructive defects of congenital heart defects

pulmonary stenosis, aortic stenosis, coarctation of aorta

Mixed defects of congenital heart defects

transportation of great arteries, trunks arteriosus, hypo plastic left heart syndrome

Atrial septal defect (ASD)

a hole in the septum between the right and left atria and results in increased pulmonary blood flow (LEFT TO RIGHT shunt). A systolic murmur and fixed split-second heart sound may be present, heart failure, and is asymptomatic 

Ventricular septal defect (VSD)

a hole in the septum between the right and left ventricle and results in increased pulmonary blood flow (LEFT TO RIGHT shunt). Is loud and harsh murmur osculated at the left sternal border, heart failure, and come early in life

Patent ductus arteriosus (PDA)

a normal fetal circulation conduit between the pulmonary artery and the aorta fails to close and results in increased pulmonary blood flow (LEFT TO RIGHT shunt). Has systolic murmur or machine hum, wide pulse pressure, bounding pulses, heart failure, rales, can be asymptomatic 

How to treat PDA

administer indomethacin to facilitate closure

Non-surgical treatments of L TO R shunt defects

closure during cardiac catheter, diuretic, extra calories if needed

Surgical treatments of L TO R shunt defects

patch closure, pulmonary artery banding (VSD), insert coils to occlude PDA during cardiac Cath, and thoracoscopic repair (ligate vessels in PDA)

Tetralogy of fallot

4 defects that result in mixed blood flow, has cyanosis at birth and get progressive cyanosis over first year of life. Has a systolic murmur and episodes of acute cyanosis and hypoxia. Goes from R TO L

4 defects in heart for tetralogy of ballot

1. Overriding aorta

2. Pulmonic stenosis

3. Ventricular septal defect

4. Right ventricular hypertrophy

Surgical procedures of tetralogy of fallout

shunt placement until able to undergo primary repair. And complete repair within the first year of life

Diagnosis of congenital heart defects

chest x-ray, ECG, echocardiogram, cardiac catheter

Nursing care for congenital heart failure

keep child hydrated, conserved Childs energy by giving frequent rest periods, clustering care, and give small and frequent meals. Activities not restricted, do daily weights and I/O, monitor vs and labs, monitor nutrition, maintain fluid and electrolyte balance, give prescribed meds, monitor family coping, maintain sodium and fluid restrictions (not usually needed after correction), position in an infant seat or hold at a 45 degree angles, consult a dietician, do GAVAGE FEED the infant if they are unable to consume enough formula or breast milk, and increase caloric density of formula.

Family education for congenital heart failure

pregnant mother should avoid certain substances and prevent infection, encourage genetic counseling for parents of children w CHDs cause of risk to have a subsequent child w CHD, children with small septal are urged to lead a normal life and often require no med intervention, therapeutic management of other forms of CHD focus on palliative care or surgical correction. ANTIBIOTICS ARE RECOMMENEDED BEFORE DNETAL PROCEDURES to reduce the risk of infective endocarditis

Congenital heart defects impact on health

heart failure, hypoxemia, growth retardation, developmental delay, pulmonary vascular disease, failure to thrive

What are are sequelae of hypoxemia

polycythemia, exercise intolerance, hyper cyanotic spells, brain abscess, CVA