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cardiac med surg

Risk factors of caridiac disease (modifiable) smoking, Obesity, high cholesterol, physical activity, diets (fats, sodium) harmful use of alcoholic drinks
Risk factors of caridiac disease (Non-modifiable) Family HX, ethnicity, Age, Gender
Blood flow through the heart Unoxygenated blood> Superior & inferior vena cava> Right atrium> Tricuspid valve,> Right Ventricle, Pulmonic> Pulmonary Artery,> Lungs,> Oxygenated, > Pulmonary Veins, > Left Atrium,> Mitral Valve,> Left Ventricle,> Aortic valve,> Aorta.
Cardiac Conduction Sa Node,>AV Node,> Bundle Of HIS,> Right & Left Bundle Branches,> Purkinje Fibers
SA Node Pacemaker of the heart
AV Node located between the right atria & ventricle carries electricle signal from the SA Node to the Bundle of HIS
Caridiac Output Amount of blood ejected from the left ventricle in 1 min.
Epinephirne increases HR, force of contraction, cardiac outpu, sytolic BP
Aldosterone Regulates Sodium/POtassium: regulates BP
Normal BP SYStolic <120 Diastolic <80
Aging Cardivascular system conduction cells less effective, Atherosclerosis, resting BP increases, Decreased HR, Vein Valves Incompetent
Conduction cells less effective Dysrhythmias
Atherosclerosis Narrowed Vessels lumens, rough surfaces>clot formation> decreased blood flow to the heart and organs.
Resting BP increases Left ventricular work load increase>Left sided Heart Failure> Stroke
Decreased HR Fatigue
Vein valves Incompetent Venous statsis ulcerations
Cardiovascular Disease #1 killer in the US
Poikilothermy loss of normal thermal regulation: temp varies with climate of the enviornment
EKG Electrocardiogram records cardiac electrical activity
Ambulatory Electrocardiogram monitoring Holter monitoring
Echocardiogram Ultrasound, records motion, heart structures, Valves, heart size, shape, and position
Transesophageal Echocardiogram Probe in Esophagus, gives a clearer Picture, NPO until Gag reflex returns
Exercise stress test (Video) Cardiac stress Test= Cardiac response to exercise and O2 demands. Peripheral Vascular stress test= Vascular response to walking.
Plethysmography Diagnoses Deep Vein Thrombosis, Pulmonary Emboli, Peripheral Vascular Disease
Pressure Measurment BP readings along Extremity
Arterial Stiffness Index Atherosclerosis/ Cardiovascular Disease
Tilt Table Test Lying to Standing BP and HR
Doppler Ultrasound Detects impaired bloodflow reduces sound waves
Radioisotopes IV, Gamma Camera Scan Detects cardiac ischemia/damage/perfusion Thallium Imagining, Technetium Pyrophosphate Scan, Technetium 99m Sestamibi MUGA scan
Blood Lipids Triglycerides(40-150), Cholesterol(<200), Phospholipids
Cardiac Biomarkers Creatine Kinase (F-10-79) (M- 17-148), Troponin(0-0.5), Myoglobin
Magnesium Norm= 1.7-2.2
Angiography Proceudre that uses a special dye and xrays to see how blood flows through the arteries of the heart.
Cardiac Cath Insertion of catheter into a chan=mber or vessel of the heart. Done for diagnostic and interventional purposes. Insertion is made through the femorla artery in the groin.
Cardiac Cath Monitor After the procedure the Nurse must assess the site for bleeding and swelling; monitor VS especially BP for signs of bleeding, pedal pulses, and maintain pressure dressing
Cardiac Cath Nursing Interventions Patient must not sit up, HOB must remain flat on bedrest for 4-6 hours after procedure. Log roll for bedpan assistance.
Electrophysiology study Done during cardiac cath procedure, Used to test for various complex cardiac arrythmias of the heart. Post procedure is same as Cardiac cath.
Therapeutic Interventions for Cardiac disease Exercise; walking, cardiac rehab, smoking cessation, balanced diet, weiht loss, O2, Antiembolism Devices- Elastic Stockings, SCD's.
HTN Increase with age, More common in blacks
Normal BP 120/80, Average of two or more readings on different dates. Highest reading determines category.
Pre-hypertension 120-139 or 80-89
Stage 1 Hypertension 140-159 or 90-99
Stage 2 Hypertension >160or >100
Blood Pressure Pressure exerted by blood on walls of blood vessels. Determined by cardiac output, peripheral Vascular resistance, Vessel Strech, Blood Viscosity & Volume
Primary HTN Unknown Cause
Secondary HTN From another medical Cause; ex. renal disease, heart disease, etc..
Isolated Systolic HTN SBP > 140
Risk Factors of HTN (Nonmodifiable) Family HX, Age, Ethnicity, Diabetes
Risk Factors of HTn (Modifiable) Weight, diet(dash, limit Sodium, limit caffeine, limit alcohol use, exercising; walking 3-4X er wk, smoking censsation, stress management, adequate sleep.Never make suggestions to patient out of these guide lines, refer them to MD if need be.
Signs and Symptoms of HTN None "Silent Killer" Rare= headache, bloody nose, anxiety, dyspnea
Diagnosis of HTN HX, S&S, kidney or heart disease, meds, home BP readings, ECG, blood glucose, HCT, K+, CA+, lipoprotein, cholesterol, triglycerides
Complications of HTN Atherosclerosis, CAD, MI, Left Ventricular Hypertrophy, Stroke, Kidney/Eye Damage
Emergency HTN Targets Organ dysfunction, immediate reduction of BP to protect target organs, SBP will be >180 & DBP > 120 TX: NITROPRUSSIDE (Nipride) IV
Antihypertensive Meds Initial therapy is (Thiazide-type diuretics), calcium channel blockers, vasodialtors, ASA 100mg @ HS
Nursing TX for HTN PT education, Lifelong BP control(self care measures, prescribed Meds)
Mitral Valve Prolapse (MVP) One or both flaps bulge into left atrium. This valve normal close during ventricular systole.
Mitral regurgitation Bulging flaps do not fit together
Mitral Valve Prolapse (MVP) Eitology Unknown cause, seen in women 20-55 years of age
Mitral Valve Prolapse (MVP) S Often none, CP, anxiety, dysrhythmias, dyspnea, fatigue, palpitations.
Mitral Valve Prolapse (MVP) Complications Dilation of left side of heart, HF, inefective endocarditis, emboli
Mitral Valve Prolapse (MVP) Diagnostic test Murmur heard, 2-D or doppler Echocardigram, Coronary Angiogram
Mitral Valve Prolapse (MVP) Therapeutic Interventions None unless symptoms present, healthy lifestle, Avoid stimulants/caffine, stress managment, Beta blockers for tachycardia, Valve Surgery for severe MVP
Mitral Valve Prolapse (MVP) Complication Mitral valve Regurgitation
Mitral Valve regurgitation Patho MItral valve incomplete closure, >back flow of blood to left atrium, > left atrium dilates,> extra blood volume to left ventricle,> left ventricle to dilates from extra volume,> eventually may fail
Mitral Valve regurgitation Causes Rheumatic Heart Disease ( Most), endocarditis, congenital defects, chordae tenineae dysfunction, mitral valve prolapse.
Mitral Valve regurgitation S None Early, Murmur, dyspnea, cough, hemoptysis, fatigue, palpitations, ATRIAL FibRIllation, CP
Mitral Valve regurgitation Complications Atrial Fibrillation, Pulmonary HTN, HF
Mitral Valve regurgitation Diagnostic test ECG=reveals P wave Changes; Chest xray= enlarged Chambers; 2-d doppler echo, Coronary angiogram
Mitral Valve regurgitation Interventions o
Aortic Stenosis Patho Aortic Valve narrows> Left ventrical contracts more forcefully,> left ventricale hypertrophies,> decreased cardiac output,> Heart failure.
Aortic Stenosis Causes Congenital Defects, Rheumatic Heart Disease, calcification with aging
Aortic Stenosis S None early, Angina, murmur, syncope, orthopena, dyspnea on excertion, fatigue, Pulmonary edema.
Aortic Stenosis Complications Heart failure, Dysrhythmias, endocarditis
Aortic Stenosis Diagnostics ECG, Chest Xray= enlarged Left ventricle, 2-d doppler echo, Serial echocardiography, cardiac cath.
Aortic Stenosis Interventions Surgery, Aortic valve replacement, Valvotomy, Treat heart failure symptoms, Propholatic ABX per criteria.
Aortic Stenosis Nursing care Pain relief (rating scale, nitro, pace activities (rest periods, conserve energy), VS, Maintain fluid volume (I&O, daily weights), sodium restrict, smoking cessation, meds as ordered (diuretics and monitor K+ level), asssess for edema.
Aortic Stenosis Teaching Meds, use anticoagulants monthly (INR/Pt test), medic alert ID, include caregivers,
Aortic Stenosis Eval of care Reports no pain,
Created by: kvoltaire