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Cardiac System pt 2
NSG 2010 Adult Nsg I for Exam #4
| Question | Answer |
|---|---|
| Cardiac output | amount of blood pumped per minute |
| Stroke volume | amount of blood pumped out of the ventricle with each contraction |
| Preload | amount of blood presented to the ventricles before systole |
| Afterload | amount of resistance to the ejection of blood from the ventricle |
| Contractibility | force of contraction |
| Ejection fraction | percentage of blood ejected from the ventricle (normal 55%-65%) |
| Heart failure | the inability of the heart to pump sufficient blood to meet the needs of the tissues for O2 and nutrients |
| Heart failure is a syndrome characterized by | fluid overload or inadequate tissue perfusion |
| The term HF indicates myocardial disease in which there is a problem with | the contraction of the heart (systolic failure & most common) or filling of the heart (diastolic failure) |
| The primary cause of heart failure | atherosclerosis of the coronary arteries |
| Left sided heart failure – S/Sx | dyspnea, cough, crackles, impaired O2 exchange, S-3 heart sound (gallop), paroxysmal nocturnal dyspnea, oliguria, orthopnea |
| Right sided heart failure – S/Sx | dependent edema, JVD, hepatomegaly, ascites, anorexia, nausea, weakness, wt. gain from retention of fluid |
| Average resting stroke volume | about 70 mL |
| Average heart rate is | 60 to 80 bpm |
| Medical management of HF | elimin or reduce etiologic or contributory factors, reduce the workload of the heart by reducing afterload and preload, optimize all therapeutic regiments, prevent exacerbations of HF, meds are routinely prescribed for HF |
| Diagnostic tests performed to dx HF | CXR, Echocardiogram (the most common test done), Electrocardiogram (EKG/ECG), lab studies (BNP, electrolytes, BUN, creatinine, CBC, TSH, cardiac catheterization |
| What meds are routinely prescribed for systolic HF? | ACE inhibitors, beta-blockers, diuretics (the most common tx), digitalis, left ventricular assist devices (LVAD) which is generally a bridge to transplant, and O2 |
| Nursing assessment of the pt with HF | health hx, sleep & activity, knowledge and coping, physical exam: mental status, lung sounds, heart sounds (S3), fluid status/signs of fluid overload, daily weight and I&O (very imp if pt is on diuretic tx. Teach your pt to weigh themselves at home, too! |
| HF – S/Sx | pale cyanotic skin, dependent edema, decreased activity tolerance, 3rd heart sound, tachycardia, increased JVD, ascites, urinary changes, dyspnea, orthopnea, crackles, cough, pink tinged sputum (pulmonary edema). [Also, diuretics can cause increased uric |
| Potential complications of HF | cardiogenic shock, dysrhythmias, thromboembolism, pericardial effusion and cardiac tamponade, pulmonary edema (most common), renal failure |
| Teaching for pt with HF | teach to pace their activities, don’t do everything at once |
| Teaching about activity intolerance for pt with HF | bed rest for acute exacerbations, encourage regular phys activity; 30-45 mins daily, exercise training, pacing of activities, wait 2 hrs after eating before doing phys activity, avoid activities in extremely hot, cold, or humid wx, modify activities to co |
| Teach pt with HF to weigh | daily at the same time and on the same scale, usu in the a.m. after urination; monitoring for a 2- to 3-lb gain in a day or 5-lb gain in a week |
| Pulmonary edema | acute event in which the LV cannot handle an overload of blood volume. Pressure increases in the pulmonary vasculature, causing fluid to move out of the pulmonary capillaries and into the interstitial space of the lungs and alveoli. Results in hypoxemia |
| Clinical manifestations of pulmonary edema | restlessness, anxiety, dyspnea, cool and clammy skin, cyanosis, weak and rapid pulse, cough, lung congestion (moist, noisy respirations), increased sputum production (sputum may be frothy and blood-tinged), decreased level of consciousness |
| Management of pulmonary edema | prevention, early recognition (monitor lung sounds and for signs of decreased activity tolerance and increased fluid retention), place pt upright and dangle legs, minimize exertion and stress, O2, medications (morphine, diuretic [furosemide]) |
| Cardiogenic shock | a life-threatening condition with a high mortality rate. Decreased CO leads to inadequate tissue perfusion and initiation of shock syndrome. |
| Cardiogenic shock - clinical manifestations | restlessness, confusion, low BP (big indicator of shock), rapid and weak pulse, increased respirations, crackles, dec. UOP, dysrhythmias |
| Cardiogenic shock – management | correct underlying problem; meds (diuretics, positive inotropic agents and vasopressors; circulatory assist devices (intra-aortic balloon pump (IABP) |
| Thromboembolism – S/Sx | dyspnea, chest pain, hemoptysis, tachycardia, feeling of dread, skin becomes mottled and blue esp below the waist (legs) |
| Dx test for thromboembolism? | D-Dimer lab. Measures if clots/fibrin exist in ody, VQ scan, X-ray |
| Med Tx for thromboembolism | thrombolytic tx |
| Nursing management for thromboembolism | prevention (ambulate, get them OOB! SCD’s (but don’t put on SCD’s if you KNOW they have a thromboembolism, compressions stockings, assess calves for pain, redness, swelling, monitor labs if on tx – PTT, PT/INR, semi-fowler position, turn, reposition, O2-N |
| Pulmonary embolism | blood clot from the legs moves to obstruct the pulmonary vessels. The most common thromboembolic problem with HF |
| What increases the risk for thromboembolism? | decreased mobility and decreased circulation |
| Pericardial effusion | the accumulation of fluid in the pericardial sac |
| Cardiac tamponade | the restriction of heart function due to this fluid, resulting in decreased venous return and decreased CO |
| Pericardial effusion – clinical manifestations | ill-defined chest pain or fullness, pulsus parodoxus, engorged neck veins, labile or low BP, SOB |
| Cardinal signs of cardiac tamponade | falling systolic BP, narrowing pulse pressure, rising venous pressure, distant heart sounds |
| The most reliable sign of cardiac arrest is | absence of a pulse. Assess carotid pulse in adult and child. In infant, assess brachial pulse |
| Sudden cardiac death | heart does not produce an effective pulse enough to circulate blood |
| PEA | pulseless electrical activity |
| Sudden cardiac death – S/Sx | most reliable sign is absence of a pulse |
| Blood pressure | cardiac output x peripheral resistance |
| HTN | a systolic pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg, based on the average of 2 or more accurate BP measurements taken during 2 or more contacts with a HCP |
| Systolic | pressure at contraction |
| Diastolic | pressure when filling |
| If you put XL BP cuff on thin pt, your will get an abnormally | low reading |
| If you put a too small BP cuff on obese pt, you will get an abnormally | high reading |
| Checking orthostatics | supine, sitting, standing – in that order; 1-3 mins between measurements |
| Orthostatic HTN | defined by changes of increase in HR greater than 20 bpm, and change of BP of systolic of 15 mm/Hg or diastolic of 10 mm/Hg |
| Pulse pressure | systolic BP minus diastolic BP |
| A pulse pressure of less than | 30 mm/Hg means a serious reduction in CO and deems further assessment |
| Primary HTN (unidentified cause) | incidence of 90-95% |
| Secondary HTN (known cause) | incidence of 5-10% |
| Incidence of HTN is greater in | southeastern U.S. and among African Americans |
| Manifestations of HTN | Usu NO sx other than elevated BP. Sx seen related to organ damage are seen late and are serious (Target Organ Damage) |
| Target Organ Damage | retinal and other eye changes, renal damage, MI, cardiac hypertrophy, stroke |
| Hypertension | increased sympathetic nervous system activity, increased reabsorption of Na, chloride and water by the kidneys, decreased vasodilation, insulin resistance (diabetes), increased activity of the renin-angiotensin-aldosterone system |
| Renin-Angiotension | Aldosterone system |
| HTN – S/Sx | the “silent killer”, target organ damage, H/A, anxiety, nosebleeds |
| HTN – Med management | initial medication tx is a diuretic, a beta blocker or both. Low doses are initiated and the med dosage is increased gradually if BP does not reach a target goal. Additional medications are added if needed. Multiple meds may be needed to control BP |
| Medication Therapy for HTN | diuretic and related drugs (thiazide diuretics, loop diuretics, K+ sparing diuretics, aldosterone receptor blockers), central alpha 2 agonists and other centrally acting drugs, beta blockers, beta blockers with intrinsic sympathomimetic activity, alpha an |
| Nursing Management – HTN | Hx and risk factors, assess potential symptoms of target organ damage. Focus on any vision changes, urination problems, chest pain. Teach s/sx of hypotension b/c their meds will cause it. |
| Nursing interventions in hospital | obtain BP q 4 hrs or as order and prn, provide low sodium diet, get dietary consult, administer meds as ordered, assess for target organ damage, monitor labs (BUN/Cr, bedside glucose), teach s/e of meds, home BP device. Teach orthostatic hypotension meas |
| Hypertensive emergency | BP greater than 180/120 and must be lowered immediately to prevent DAMAGE TO TARGET ORGANS |
| Hypertensive urgency | BP is very high but NO EVIDENCE OF immediate or progressive target organ damage |
Created by:
mlewellen
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