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cardiac patient care

care of patients with cardiac problems c37 med

types of heart failure left-sided (CHF), right-side, high output
Most heart failure beings with failure of the? left ventricle
typical causes of left-sided heart (ventricular) failure hypertensive, coronary artery and valvular disease of mitral or aortic valve.
indications of left ventricular failure (LVF) decreased tissue perfusion from poor CO and pulmonary congestion from increased pressure in pulmonary vessels
Variations of left-sided heart failure acute, chronic, mild, severe. systolic HF and diastolic HF
systolic HF (systolic ventricular dysfunction) heart cannot contract forcefully enough during systole to eject adequate blood into circulation.
ejection fraction percentage of blood ejected from heart during systole
diastolic heart failure (heart failure with preserved left ventricular function) left ventricle cannot relax adequately during diastole.
right-sided heart (ventricular) failure causes left ventricular failure, right ventricular MI, pulmonary hypertension.
right-sided heart failure right ventricle cannot empty completely.
high-output heart failure can occur when CO remains normal or above normal. Caused by increased metabolic needs or hyperkinetic conditions (septicemia (fever), anemia and hyperthyroidism). Not as common.
When CO is insufficient, ____ operate to improve CO compensatory mechanisms
major compensatory mechanisms include: sympathetic NS stimulation, Renin-angiotensin system activation, chemical responses, myocardial hypertrophy
most immediate compensatory mechinism stimulation of sympathetic NS
afterload the resistance against which the heart must pump
renin-angiotensin system activation occurs as a response to? reduced blood flow to the kidneys, common in low-output states.
When endothelial cells are stretched what is secreted? endothelin
myocardial hypertrophy enlargement of myocardium, walls of heart thicken to provide more muscle mass, thus more forceful contractions increasing CO. oxygen supply is not as fast as growth of heart.
75% of the cases of HF are caused by systemic hypertension.
Second most common cause of HF is structural heart changes.
common risk factors/causes of HF hypertension, coronary artery disease, cardiomyopathy, substance abuse, valvular disease, congenital defects, cardiac infections and inflammations, dysrhythmias, diabetes, family history, hyperkinetic conditions (e.g. hyperthyroidism)
right sided HF in the absence of left-sided Hf is usually a result of pulmonary problems
describe a cough related to HF irritating, nocturnal and nonproductive. severe HF - expectorating frothy, pink-tinged sputum (sign of pulmonary edema)
exertional dyspnea patient often stops previously tolerated levels of activity because of SOB
orthopnea dyspnea in recumbent (lying flat) position
paroxystmal nocturnal dyspnea sudden awakening with feeling of breathlessness 2 to 5 hours after fallin gasleep.
proportional pulse pressure systolic bp - diastolic bp % systolic BP
impaired gas exchange expected outcomes normal; pulmonary artery pressure, respiratory function, respiratory rate, ABGs and pH, oxygen saturation
decreased CO expected outcomes normal; systolic/diastolic bp, apical pulse rate, ejection fraction, peripheral pulses, skin color, urine output, cognitive status
impaired gas exchange interventions monitor respiratory rate, rhythm and quality q1-4h. auscultate breath sounds q4-8h, oxygen as ordered, high fowlers (if dyspnea), pillows under each arm. repositioning, cough deep break q2h.
mitral valve prolapse occurs because valvular leaflets enlarge and prolapse into the left atrium during systole. usually benign but may progress to pronounced mitral regurgitation.
aortic stenosis aortic valve orifice narrows and obstructs left ventricular outflow during systole.
expected outcomes for activity intolerance balances activity/rest, uses naps to restore energy, recognizes limitations, organizes activities to conserve energy, adapts lifestyle to energy level, reports adequate endurance for activity.
key features of pulmonary edema crackles, dyspnea at rest, disorientation, tachycardia, hypertension, hypotension, reduced urinary output, cough with frothy pink tinged sputum, premature ventricular contractions, dysrhthmia, anxiety restlessness, lethargy
after a mitral valve replaceent patients will be on what type of medication for the rest of their lives anticoagulant, such as coumadin
infective endocardidits infection of endocardium.
pericardial effusion complication of pericardidis, when space between parietal and visceral layers of the pericardium fill with fluid. puts patient at risk for cardiac tamponade
cardiac tamponade excessive fluid within the pericardial cavity, restricting diastolic ventricular filling and CO. symptoms: JVD, paradoxical pulse, decreased CO, muffled heart sounds, circulatory collapse
rheumatic carditis is a major indicator of rheumatic fever
signs of rheumatic fever tachycardia, cardiomegaly, new or changed murmur, pericardial friction rub, precordial pain, ecg changes (prolonged PR interval), indications of HF, evidence of strep infection
indications of streptococcal pharyngitis moderate to high fever, abrupt onset of sore throat, reddened throat with exudate, enlarged and tender lympth nodes
classifications of cardiomyopahty dilated, hypertrophic, restrictive and arrhythmogenic right ventricular
signs of heart transplant rejection SOB, fatigure, fluid gain, abdominal bloating, new bradycardia, hypotension, atrial fibrillation or flutter, decreased activity tolerance, decreased ejection fraction (late sign)
Created by: FSclafani
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