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nctc med surg cardia

What is the function of the heart? The heart is a muscle that maintains the flow of blood to and from the brain and the body. It sends deoxygenated blood to the lungs to become oxygenated. It then sends the oxygenated blood to the brain and the body.
* What are the four valves in the heart and where are they located? * Tricuspid valve - between the right atrium and right ventricle * Pulmonic valve- between the right ventricle and pulmonary artery * Mitral valve- between the left atrium and left ventricle * Aortic valve - left ventricle and the aorta
S1-lub formed when the ventricle contracts and the mitral and tricuspid valves close
S2-dub- formed during ventricular relaxation when the aortic and pulmonic valves close
S3- ventricular gallop normal in children and young adults, usually indicates CHF in adults >30.
S4- atrial gallop usually indicative of impending MI
How is blood supplied to the myocardium? 3 main vessels- Right Coronary Artery, Left Anterior Descending & Circumflex
Arteriosclerosis lining of walls of arteries and arterioles becomes thickened and hardened and lose elasticity, which leads to inability to stretch
Atherosclerosis a form of arteriosclerosis where thickening of the artery walls is caused by soft deposits in the intima that harden over time. Ex: LDL cholesterol
What causes CAD? * Arteriosclerosis * Atherosclerosis * Clot formation * Vascular spasm
What are some of the S/S of CAD? * CP called angina pectoris * Pain is due to lack of O2 to the tissues * HTN * *Patients are usually asymptomatic until blood supply reduced by 60%
List some common s/s of angina. “elephant on chest” chest pressure or chest tightness radiation of pain to left arm or jaw pale diaphoretic SOB N/V “Stable” angina may be relieved with rest
Stable - 75% coronary occlusion coronary arteries can’t dilate anymore increased activity increases workload and O2 demands on heart, which leads to CP * pain decreases with decreased activity
Unstable (crescendo) - 90% coronary occlusion shows up as CAD worsens CP increases in frequency and severity does not decrease with rest or PO Nitro high risk of AMI & death within 18 months
Prinzmetal’s angina (variant) pain same as stable but lasts longer and occurs at rest caused by coronary artery spasm May occur despite absence of atherosclerosis no damage to myocardium
Microvascular angina (Cardiac Syndrome X) constriction of myocardial capillaries
Cardiac Glycosides increases force of contraction-positive inotropic effect, slows heart rate by delaying impulse through the AV node
Vasodilators relaxes all smooth muscles causing dilation of blood vessels, increases blood flow to coronary arteries
Calcium Channel Blockers relaxes smooth muscle-decreases afterload
Beta Blockers decreases workload on heart by decreasing CO * decreases effects of epinepherine and norepinepherine-decreases vasoconstriction DO NOT use with heart failure or pt’s with COPD * May cause bronchial constriction
Analgesics Morphine Sulfate (MSO4) * MONA Morphine,O2, Nitro,Asprin - Chest pain
Describe a MI and how it occurs. Actual death of myocardial tissue from complete and total loss of O2, due to obstruction of blood flow to a coronary artery
* Cardiac Troponin I specific for cardiac injury when increased
* CK & CK-MB increased due to damage seen with cell death * rise in 4-12 hr * peak in 24 hr * normal in 3-4 days
Angiography apply pressure for 30 min when cath removed assess VS, pulses, and check for hemorrhage q 15 min encourage fluids to flush dye
What care will the nurse provide after a cardiac cath/angioplasty? * VS q 15 min x 4, then q 30 min * Monitor site for bleeding with VS * Check distal neurovascular status with VS * Keep leg straight, may use soft restraint * May use a sandbag to groin * Must lay flat for 6 hours * Use bed pan or urinal-NO BSC
What is the purpose of a CABG? * coronary artery bypass graft surgery is performed to improve the blood supply to the myocardium
What medication reverses Coumadin? Aquamephyton or Vitamin K
What is the antidote for Heparin? * Protein sulfate or Protamine
What is cardiogenic pulmonary edema and what is the cause? Fluid accumulation in the lungs caused by left sided heart failure
What does the left side of the heart have to do with the lungs? Blood empties into the left side of the heart from the lungs. This blood is oxygenated.
What causes left-sided heart failure? * HTN is a major cause of left-sided heart failure
What are the classic S/S of cardiogenic pulmonary edema (left-sided CHF)? * restlessness, agitation * pale, cyanosis * tachycardia, increased BP * severe SOB * orthopnea * use of accessory muscles * rapid respirations, cough * crackles, wheezes, pink frothy sputum * increased CVP with JVD * pink, frothy sput
What symptoms would indicate a worsening of CHF? * decreased LOC * cyanosis * quiet, shallow respirations
What is ventricular hypertrophy? Enlargement (dilation) of the left ventricle due to long term HTN
right-sided failure? * engorged organs * total body swelling * dependent edema
left-sided failure? * pulmonary symptoms
Cardiomyopathy Chronic condition due to structural changes in the heart muscle
Dilated Cardiomyopathy decreased contractility leads to back up of blood in all 4 chambers which leads to left ventricular failure and CHF
Hypertrophic Cardiomyopathy thickening of left ventricular septum and mitral valve leads to increased size of left atrium
Restrictive Cardiomyopathy myocardium becomes rigid, CO & ventricular filling decreases, back up occurs and congestion results-chambers all decrease in size
What is bacterial endocarditis? may also be called infective endocarditis- Infectious microorganisms invade the endocardium, primarily the valves
What are the usual causative agents for bacterial endocarditis? * Beta-hemolytic streptococci, E-coli, streptococcus viridans, fungi
What are the S & S of bacterial endocarditis? * Fever - most common sign * CP, dyspnea * Chills, night sweats, fatigue, malaise * Weight loss, weakness, abdominal pain * Anorexia, generalized pain in joints * Murmur, pericardial rub
What do petechiae indicate? in endocarditis * Petechiae due to embolization of microorganisms
What teaching will you do regarding Coumadin, and what is the therapeutic range? * reduces risk of emboli * avoid sharp objects, use electric razor, soft tooth brush, call for any abnormal bleeding * PT: 1.5 to 2.0 times the normal/control
What is myocarditis? an inflammation of the myocardium.
Number one drug used in cardiac arrest epinephrine
Cardiac rehab
compensation occurs when BP starts dropping HR will increase * Baroreceptors in heart stimulate the increase in HR to compensate for decrease in BP
Created by: kcorkinsnctc