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Ch 210 Cardiac

Ch. 29-32

Mitral Valve Prolapse few s/s except "mitral click", mitral valve leaflets balloon back into the atrium
Medical Mgmt for Mitral Valve Prolapse eliminate caffeine/alcohol/smoking
Nsg Mgmt for Mitral Valve Prolapse inherited, risk for endocarditis, no surgical tx
Mitral Regurgitation blood flowing back into L atrium causing hypertrophy
S/S mitral regurgitation high pitched systolic murmur blowing snd, dyspnea, fatigue, cough, crackles, S3, S4
Medical mgmt for Mitral regurgitation rest, low Na diet, lasix, nitrate, ACE inhibitors, ARBs, beta blockers
Mitral Stenosis obstruction of blood flowing from L atrium to L vent caused by rheumatic endocarditis. Back up to R vent causing strain. Low pitch diastolic murmur
What heart dysrhythmia does most stenosis cause Atrial fibrillation cause strain on atrium
Aortic regurgitation back flow into L vent from aorta. hypertrophy of L vent so incr sys BP,
s/s aortic regurgitation or L vent failure orthopnea, breathing issues, high pitched diat murmur, PP widens,
Medical mgmt for aortic regurgitation rest, CCB, ACE inhibitors, hydralazine
Aortic Stenosis narrowing bn L vent and aorta amniodarone- beta blocker
Valvuloplasty(repair) Closed/open commissurotomy annuloplasty chordoplasty closed-break stuck valve open- open heart surgery annul: ring, leaflet repair chor: tighten chordae tendinaea
Xenografts homografts autografts xeno: pig, no clots(no coumadin needed), >70y and women of childbearing age bc no coumadin homo: cadaver, throw clots auto: self, no clots
nsg mgmt for grafts VS, INR want to b 2-3.5, if >4 not give. This is above norm of 2-3 x normal of 1
Mechanical Valve replacements are going to need what med 4ever? coumadin cause mechanical not as smooth. Also BP will change with new valve, so educate on new meds
cardiomyopathies(heart muscle prob) dilated: enlarged vent area, less muslce to pump: HF hypertrophic: overgrowth in septum, vent can't fill, decr CO, avoide dehydration restrictive: rigid vent walls, stiff muscles
Med mgmt for dilated cardiomyopathy? hypertrophic? dil: dig, vasodilators, diuretic, decr Na diet, sit up/legs dangle hyper: beta blockers(to maintain CO), rest, CCB(relax so can squeeze more)
What drug helps body not reject transplant? cyclosporine
Orthotopic transplantation? Heterotopic? VAD? cut off bottom and attach donor to bottom half. Het: new heart parallel to old Vad: vent assisted device, pt must gradaully incr excercise bc no nerve
Infective Endocarditis is occuring where? and caused by? inner lining cause: strep, rheumatic heart dis, staff after valve replacement, IV drug users Pt at risk for repeat, so prophylaxis at dentist
s/s of infective endocarditis fever, heart murmur, chills, malaise, wt. loss, Roth's spots(eye), Osler nodes(fingers), splinger hemm(fingernails)
nsg mgmt get three sets of blood cultures, need rest wtih ADL's, watch for emboli, oral hygiene
Myocarditis cause: radiation, lead poison/lithium/cocaine/HIV s/s: flulike Nsg: sensitive to dig toxicity/use PAS hose
s/s of dig toxicity: Dig: Incr squeeze, lower HR dysrhythmias, anorexia, HA, N/V, green/yellow halo If pulse <60, don't give
Pericarditis inf in sac around the heart, sac strangles heart so can't pump or fill s/s: friction rub, tamponade, chest pain tx: sit up and lean forward
Rheumatic Endocarditis due throat culture for strep nsg: finish antibiotics
Cardiac Tamponade s/s: decr BP cause heart can't pump, PP narrows, distant heart sounds, rising venous pressure, pulsus paradoxus(weak pulse on insp/strong-exp), friction rub(rest til gone)
preload amt of blood presented to vent b4 systole determined by venous return to heart
what lowers preload hypertrophic cardiomyopathy of vent, stiff fibrotic tiss after MI All these incr press and load on heart so lead to HF
afterload amt of resistance to ejection of blood from vent overcoming resistance. Incr will decr SV cause vent work harder
What affects afterload diameter/stretch of vessels and open/competence of lunar valves incr after: HTN, vasoconstriciton, stenosis..incr work of heart
contractility force of contraction from condition of myocardium. Sympathetic stimulation incr and MI with damaged cells lower contractility. Lower afterload to lower contractility
Assess rt vent preload? L vent afterload? R vent pre: measure jugular venous distention(JVD) L vent after: MAP
CHF-congested Heart Failure? fluid overload/not tissue perfusion so not enuf CO for body's needs, progressive
Two types: systolic heart failure? diastolic HF? sys: squeeze failure, weak heart muscle, EF reduced diast: weak fill, stiff/ noncompliant heart muscle, EF normal Assess ejection fraction to determine which one it is
Understanding fluid vol overload in HF decr EF from vent, SNS stim vasoconstiction, kidney perfusion decr due to low CO so renin tells angio I to make II to incr bp and afterload. II gets aldosterone released to save Na/H2O and ADH holds H2O so fluid overload
How overload stresses heart and cause diastolic HF fluid overload incr afterload/preload so BNP/ANP released from overdistended chambers and promote vasodilation/diuresis. Contractility decr, incr vent filling and size, so thickens walls
Causes of HF Cornoary art dis, cardiomyopathy, HTN, valvular disorders, renal disorders,
S/s L heart failure? R heart failure? L: pulmonary congestion bc L atrium press incr, incr pulmonary press making pulmonary edema and impaired gas exchange s/s: dyspnea, cough, crackles, low O2, S3(lg vol of fluid enter vent beg of diast)
more s/s of L sided heart failure PND: paroxysmal nocturnal dyspnea- fluid gathers at night so sit up. Pink frothy sputnum(pul edema), oligura(kidney reduce output cause low blood flow),
R sided heart failure s/s dependent edema, hepatomegaly, ascites, wt gain
Diagnostic findings with HF elevated BNP. Normal: <100 suggestive HF: 100-300 mild HF: >300 moderate HF: >600 severe HF: >900
Pharm therapy for HF: Ace inhibitors? ACE: for systolic HF, "prils", promote vasodilation/diuresis by decr after/preload, block angio I to II
how do ACE help with diuresis decr secretion of aldosterone and stim kidney to release Na/h2o while retaining K. SE: cough, hyperkalemia
Affects of ARBs "sartans", block affect of angio II at receptor, decr bp, incr CO, if ACE give cough, give ARB
hydralazine/Isosorbide Dinitrate(nitrate) venous dilation so lower amt of blood return to heart so lower preload
Beta blockers Nothing goes up, "olols" block sympathetic stimulation, dilate SE: hypotension, dizzy, bradycardia tx: start at low dose and not give to asthma pt
diurectic loop:lasix, hypoK thiazide:HCTZ, hypoK K-sparing:
Dig(Lanoxin) incr force of contraction and slows conduction thru AV node, can see heart blocks, assess apical 1m,
CCB Verapamil(Calan), nifedipine (Procardia), diltiazem (Cardizem), Amlodipine(Norvasc), Plendil....vasodilation, shades on not see SA node
cardiogenic shock decr CO leads to inadequate tissue perfusion and initiation of shock usually caused by MI
Test for PE D-dimer tests for pieces of clots in blood
How much volume of blood is in venous sys 75% of blood
What is the most important factor in regulating blood flow of peripheral blood vessels sympathetic (adrenergic) NS...vasoconstriction by norepi
intermittent claudication muscle cramping in extremities wtih excercise adn relieved by rest in pt w/ arterial insuff.
color of skin rubor: reddish-blue seen in 20 sec-2m after placed in dependent position, suggests art damage and can't constrict
Calculate ABI ankle brachial index ratio of syst bp in andle to sys bp in arm... pt in supine pos norm in ankle is 1.0. pt with claudication have .95 to 0.50
What does angiography show? dx of occlusive arterial dis, aneurysm(abn dilation of vessel)
what is arteriosclerosis? atherosclerosis? art:"hardening", thickened artioles/aa ath: intima of lg aa of blocked w/ plaques, stenosis
Risk factors for atherosclerosis smoking/diet/htn/dm/obesity/stress/elevated C-reactive protein/age/female
What is nsg intv for using hot water bottle to help dilate extremities? put hot water bottle on abd cause reflex vasodilation in extremities
PAD Peripheral Arterial Occlusive Disease is usually where? s/s? Usually bn renal and popliteal aa s/s: intermittent claudication relieved by putting limb in dependent position tx: Trental, Pletal, excercise, aspirin, plavix,
Buerger's Disease s/s? inflammation of int/sm aa, vv or lower/upper extremities, form thrombus, autoimmune, men20-35y s/s: pain in arch after excercise tx: stop smoking, keep circulation
Major cause of aneurysm? thoracic aortic aneu? Adb aortic aneu? atherosclerosis s/s: pain, unequal pupils, dx w/ chest xray/TEE(grafts), pulsing abd
Arterial Embolism? thrombosis? emboli from thrombi as a result of atrial fibrillation s/s: 6P's: pain/pallor/pulselessness/paresthesia/poikilothermia(coldness)/paralysis
What is Raynaud's Phenomenon? arteriolar vasoconstriction get cold/pain/pallor figertips/toes. 2 types: Primary/idiopathic, Secondary s/s: vasospasms then stop (white, blue,red) tx: avoide cold, tobacco, stress
DVT and PE= Virchow's triad VTE- venous thromboembolism triad: stasis of blood(immobility), vessel wall injury(fracture, IV meds), altered blood coagulation(off anticoagulation med)
Phlebitis(inflammation of vein walls) can accompany thrombus
nsg intv for DVT mark circumference of extremity, check temp, redness, tenderness, not do Homan's sign tx: compression stockings(remove at night), PAS hose, heparin with thrombolytic tx: warm moist packs
pharmacology for VTE heparin, LMWH, coumadin, thrombolytic, thrombin inhibitor, Folndaparinux(prophylaxis)
Use of heparin and coumadin adn therapuetic ranges hep is in range when aPTT is 1.5x(antidote: protamine sulfate) warfarin(antidote: VitK) effect is delayed so given w/ heparin til aPTT is 1.5-2x and INR is 2-3x
complications of heparin hemorrhage, thrombcytopenia(decr in platelet count),
Venous insufficiency? Postthrombotic syndrome? insuff: obstruction of valves or reflux of blood thru valves post: venous stasis w/ edema,pain, dermatitis(ulceration) tx: elevation, protect from trauma
varicose veins abnormally dilated superficial vv cuased by incompetent valves
Cellulitis? bacteria enter tissue w/ swelling, redness, pain, fever, chills, sweating tx: antibiotics
HTN? 140-160/90-100, leads to hypertrophy of L vent tx: decr peripheral resis/blood volume/strength, rate of contraction
pharm for htn 140-90: thiazide diuretic &/or ACE, ARB, BB, CCB? >160/100: thiaz+ace/arb/bb/ccb
Understanding drugs thiazide diurectic? loop? K-Sparing? aldosterone blocking l: vol depletion, blocks reabsorption of Na/Cl/h2o Lasix, Bumex, demadex
Thia: decr blood vol, renal blood flow, CO, affect vascular smooth muscle, maintain BP K-spar: block Na reabsorption in distal tubule, (hyperkalemia) (amiloride)Midamor, (triamtorene) Dyrenium
Aldosterone blocker: for MI and vent dysfx, hyperkalemia, spironalactone (aldactone), Inspra Methyldopa- displaces norepi, good for pregnant Clonidine: lower bp,
BB beta blockers: block sympathetic ns, slow HR, decr BP, reduce pulse in tachy SE: cough, depression, check hr b4 ACE inhibitors: lower peripheral resistance by inhibit conversion of angio I to II which vasoconsricts Can be used with thiazide and dig
ARBs: block angio II at receptor, reduce peripheral resistance CCB: reduce cardiac afterload Dihydropyridines: rapid action, vasodilator, decr cardiac work load and O2 demand(cardene)
hypertensive emergency? hypertensive urgency? emer: 180-120 tx: vasodilators(nitropress)... urg: nose bleeds, anxiety, HA tx: BB, ACE inh
Created by: palmerag