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GWCC Block 2 nursing

myocardial ischemia a painful heart condition caused by lack of blood flow to the heart
angina pectoris (stable) typically occurs with activity or stress. The pain usually begins slowly and gets worse over the next few minutes before going away. It quickly goes away with medication or rest, but may happen again with additional activity or stress.
angina pectoris (unstable) When the heart doesn't get enough blood flow and oxygen. It is a prelude to a heart attack. Most people experience a feeling of chest discomfort or shortness of breath.
coronary artery spasm (Prinzmetal's angina) a temporary, sudden narrowing of one of the coronary arteries (the arteries that supply blood to the heart). The spasm slows or stops blood flow through the artery and starves part of the heart of oxygen
Acute Coronary Syndrome (ACS) Umbrella term used to cover any group of clinical symptoms compatible with acute myocardial ischemia: chest pain due to insufficient blood supply to the heart muscle that results from coronary artery disease (also called coronary heart disease).
NSTEMI "non-ST segment elevation myocardial infarction"--blood clot only partly occludes the artery, and as a result only a portion of the heart muscle being supplied by the affected artery dies  
STEMI "ST segment elevation myocardial infarction"
Unmodifiable risk factors for CAD age, gender, ethnicity, genetic inheritance.
Modifiable risk factors for CAD Elevated serum lipids, hypertension, smoking, obesity, physical inactivity, stress. Control of diabetes is highly recommended in relation to CAD because high glucose levels accelerates atherosclerosis.
The incidence of MI is highest among which population? white, middle-aged men. After age 65 the incidence in men and women equalizes.
Why do women have CAD earlier? lifestyle changes: stress, increased cigarette smoking, hypertension, birth control pills.
Explain family history and CAD Congenital defects in coronary artery walls predispose person to plaques. Hypercholesterolemia can lead to early CAD.  
Explain elevated serum lipids and CAD. CAD associated with cholesterol of 200 or higher, or triglyceride of 200 or higher. Elevated triglycerides associated with obesity, inactivity, high alcohol intake.
Explain HTN and CAD. HTN = 140/90 on two separate occasions (persistent). Increases risk of atherosclerotic development. R/t shearing stress causing shredding to endothelial lining. Atherosclerosis causes narrow, thick arterial walls.  
Explain smoking and CAD. 2-6x higher in smokers.
Regular exercise defined as 3x week for at least 30 minutes, causing perspiration and increased HR of 30
Obesity and CAD Obese people produce higher levels of triglycerides and cholesterol. Obesity associated with HTN. As obesity increases, the heart size increases and causes increased myocardial oxygen demand. Increase in diabetes mellitus in obese people.
Stress and CAD Stress increases the heartrate and force of myocardial contraction. Increases O2 demand of heart. Stress causes elevated lipids and alterations in blood coagulation, leads to atherosclerosis.
Homocysteine An amino acid that is produced by a breakdown of essential amino acid methionine, which is found in dietary protein. High Homocysteine levels leads to atherosclerosis by damaging inner blood vessel linings.
The person with a serum cholesterol of ___ is at high risk of CAD. above 200
Percutaneous Transluminal Coronary Angioplasty (PTCA) balloon cath inflated in arterial wall to split plaque.It stretches the arterial wall and dilates the diameter of the vessel. A rotoblade is used to pulverize plaque.
Arthrectomy a cath with a collection chamber is used to remove plaque that is trapped in the chamber.
Coronary artery bypass graft (CABG) blood flow is rerouted through a new artery or vein that is grafted around diseased sections of your coronary arteries to increase blood flow to the heart muscle tissue.
Coronary laser therapy Excimer lasers open blocked arteries. Emitted from the tips of catheters threaded into diseased arteries, the laser helps to open up blockages and restore blood flow.
Coronary artery stent Angioplasty is sometimes combined with placement of a small metal coil called a stent in the clogged artery to help prop the artery open and decrease the chance of it narrowing again (restenosis).
Administer nitroglycerin (NTG) 1 SL q5mX3, then call 9-1-1 if no relief
Myocardial Infarction Disruption in or deficiency of coronary artery blood supply, resulting in necrosis of myocardial tissue
Causes of MI Thrombus or clotting; Shock or hemorrhage
MI pain differs from angina by its sudden onset; Pain is not relieved by rest; Pain is not relieved by NTG; persists for hours or days, vice-like, pressure, radiates.
Why is morphine administered during MI? Morphine is a vasodilator and decreases venous return.
Nursing intervention during MI Ensure you have IV access! Obtain VS, EKG;Administer oxygen; Administer MORPHINE; Assess cardiac and breath sounds
Buerger’s disease an occlusive inflammatory disease that is strongly associated with smoking. Thromboangiitis obliterans is a rare disease in which blood vessels of the hands and feet become obstructed.
Acute occlusion An example of acute occlusion would be a thrombi or emboli.
Varicose veins are swollen, twisted, and sometimes painful veins that have filled with an abnormal collection of blood.
Thrombophlebitis define and s/s swelling (inflammation) of a vein caused by a blood clot. Inflammation (swelling) in the part of the body affected; Pain in the part of the body affected; Skin redness (not always present); Warmth and tenderness over the vein; Venous stasis ulcers
PVD associated diseases- arterial Raynaud's disease, Buerger's disease, diabetes, accute occlusion
PVD associated diseases- venous Varicose veins, thrombophlebitis, venous stasis ulcers
arterial PVD: appearance of skin, hair, nails, color Smooth skin Shiny skin loss of hair Thickened nails; Color-- pallor on elevation, and rubor when dependent.
venous PVD: appearance of skin, hair, nails, color Brown pigment around ankles. Color becomes cyanotic when dependent
DAVE   (dangle arteries, veins elevate).
Arteries carry blood away from the heart.  If the legs are dependent in arterial disease then the blood is getting to the feet better than when they are elevated (and have to push up hill). 
In venous disease if the legs are dependent the veins cannot carry the blood back up to the heart (become cyanotic) and do better when elevated!
PVD arterial, pulses cool, decreased or absent pulses
PVD venous, pulses warm, normal pulses
PVD arterial, pain sharp, increased with walking and elevation, intermittent claudication, rest pain.
PVD venous, pain persistent, aching, full feeling, dull sensation, relieved when horizontal (elevated) and TED hose.
PVD arterial, ulcers demarcated edges, necrotic, not edematous, very painful, occur on lower legs, toes, heels.
PVD venous, ulcers uneven edges, superficial, marked edema, occur on MEDIAL legs, slightly painful.
PVD arterial, non-invasive medical treatment of skin and ulcers topical antibiotics, saline dressing, bed rest, immobilization, possibly fibrinolytic therapy if clots a problem, stop smoking.
PVD venous, non-invasive medical treatment of skin and ulcers systemic anti-biotics, compression devices, limb elevation, fibrinolytic therapy if thrombosis is present.
PVD arterial, surgical treatment: embolectomy, endarterectomy, arterial bypass, percutaneous transluminal angioplasty (PTA), amputation
PVD venous, surgical treatment: vein ligation, ablation, thrombectomy, debridement
Intermittent claudication is a classic symptom with ___ disease arterial,it occurs in skeletal muscles during exercise and is relieved with rest.
Intermittent claudication, pain at rest Pain that occurs with rest when the extremities are horizontal and may be relieved by putting legs in dependent position. Often appears when collateral circulation fails to develop as disease process advances.
Thrombophlebitis Inflammation of the  venous walls with the formation of a clot; also known as venous thrombosis, phlebothrombosis, deep vein thrombosis
Assessment of PVD- what direction Inspect legs from groin to feet, measure diameters of calf.
Ineffective tissue perfusion is the decrease in oxygen resulting in failure to nourish tissues at the capillary level.
Cardiopulmonary- Ineffective tissue perfusion s/s Abnormal ABGs, altered resp rate, arrythmias, bronchospasms, cap refill>3 sec, dyspnea, nasal flaring, sense of impending doom, use of accessory muscles
Cerebral- Ineffective tissue perfusion s/s Altered mental status, behavior changes, changes in motor response, changes in papillary reactions, difficulty swallowing, extremity weakness, paralysis, speech abnormalities
GI- Ineffective tissue perfusion s/s Abdominal distention, abd pain or tenderness, absent bowel sounds, hypoactive bowel sounds, nausea
PAD- Ineffective tissue perfusion s/s Altered sensation, alt. skin/ nail characteristics, cold extremities, dim pulses, intermittant claudication, pale skin,elevation with color not returning upon lowering leg; pallor, shiny waxy skin, skin temp chagnes, slow healing, weak or absent pulses
PVD- Ineffective tissue perfusion s/s Edema, brawny hemosideric skin discoloration, dependent blue or purple skin color, positive homan’s sign, slow healing of lesions
Renal- Ineffective tissue perfusion s/s Altered BP outside of acceptable parameters, anuria, elevation of BUN/Creatinine ratio, hematuria, oliguria
Heparin- labs, duration, route, reversal PTT/aPTT; Always IV or SQ; Short term; Reversal protamine sulfate.
Low-molecular weight heparin- drug name, labs, route, duration Lovenox, SQ ; Short term; No labs! Protamine sulfate reversal. Must give it on time.
coumadin/ warfarin - labs, route, duration, reversal PT/INR; PO; Long term; Reversal Vit K. Coumadin stabilizes clots and prevents them from becoming bigger.
What does Heparin do? Heparin interrupts clotting cascade: prevents conversion of fibrinogen and prothrombin to thrombin.
Heart Failure (previously known as CHF) The inability of the heart to pump enough blood to meet the tissues oxygen demands.
Ischaemic or ischemic heart disease (IHD), or myocardial ischaemia a disease characterized by ischaemia (reduced blood supply) to the heart muscle, usually due to coronary artery disease (atherosclerosis of the coronary arteries).
Cardiomyopathy An enlarged heart that no longer pumps effectively. Some ccardiomyopathies have known causes, such as alcoholic cardiomyopathy. Many occur for no known reason, and are called idiopathic.
Angioplasty A procedure in which a balloon-tipped catheter is inserted through a vein and into the blocked portion of a coronary artery to enlarge the narrowing. Also called percutaneous transluninal coronary angioplasty (PTCA)
Valvular heart diseases heart disease caused by stenosis of the cardiac valves and obstructed blood flow or caused by degeneration and blood regurgitation
cues to cardiovascular problems fatigue, fluid retension, irregular heartbeat, dyspnea, pain, tenderness of calf and leg, syncope (or near syncope-- fainting), altered neurological function (changes in sensory/motor function), leg pain.
Measuring orthostatic BP BP and HR should be taken when lying, sitting, and standing. Normal to have a slight change in BP. HR should NOT increase more than 20 from supine to standing. BP may vary 5-15 in each position and in each arm and also leg to arm difference of about 10.
Palpitation of pulses scale 0=absent; 2+= normal, 4+=bounding
Normal triglyceride levels 40-190. Above this indicates risk for cardovascular problems.
Normal cholesterol levels 140-200. Elevated is at risk for atherosclerosis.
Normal lipoprotein levels (HDL & LDL) LDL below 130, HDL at least 35
Cardiac catheterization test insertion of cath into heart to read O2 sats and pressure readings within heart chambers.
coronary angiogram (angiography) injection of dye into coronary arteries to evaluate patency of arteries and any blockages/calcificiations
HTN defined as SBP greater than 140, and/or diastolic greater than 90-- this is Stage 1. Stage 2 is greater than 160/100
What can affect CO? heart rate, humoral (related to body fluids), inotropic state, neural, renal fluid/volume control
What can affect SVR? SNS, humoral (vasoconstrictors), local (vasodilators and vasoconstrictors)
Primary vs. Secondary HTN Primary has no known cause; secondary is related to a disease process.
Renal manifestation of cardiac disease creatinine greater than 1.5
Common complications of HTN are target organ disease including heart, brain, PVD, kidney, eyes.
Hypertensive heart diseases include CAD, left ventricular hypertrophy (HTN causes increased work load), heart failure (heart can no longer pump enough to meet body's needs).
Left ventricular hypertrophy caused by sustained HTN causes enlarged heart to strengthen contractions, but this causes increased need for O2 and nutrients to the heart. When heart can no longer meet needs for myocardial O2, heart failure occurs.
Cerebrovascular disease artherosclerosis of carotid arteries break off and cause thromboembolism of brain. Also caused by hypertensive encephalopathy (swelling of brain, increased ICP)
Nephrosclerosis ischemia caused by narrowed lumen of intrarenal blood vessels. Causes death of nephrons. Nocturia common, elevated BUN, creatinine, protien/albumin in urine.
Drugs given for HTN Kidneys: thiazide-type diuretics, loop diuretics (more potent, short duration of action), then ACE inhibitors, ARB. Heart: BB, CCB.
How to assess PB in cardiac patient BP taken x2, 1 minute apart, both arms. Take average of two readings. Initially take BP of both arms, use arm that has higher reading for all subsequent readings.
Hypertensive crisis vs. Hypertensive emergency Crisis- abrubt elevation of BP >140 triggers endothelial damage. Classified by degree of organ damage; HTN emergency is >180 and organ damage is occuring.
s/s of hypertensive emergency headache, nausea, vomiting, seizures, confusion, stupor, coma. Blurred vision, transient blindness. Renal decline, pulm. edema, rapid cardiac decompinsation and s/s of heart attack.
Goals for treating acute decompenstated heart failure (ACHF)- 6 goals 1. decreasing intravascular volume; 2. decreasing venous return; 3. decreasting afterload; 4. improving gas exchange and oxygenation; 5. improving cardiac function; 6. reducing anxiety
How does decreasing interavascular volume help with HF? by decreasing venous return to the LV, preload is decreased, heart may contract more effectively and improve CO. Method: diuretics
How does decreasing venous return help with HF? Decreasing venous return (preload) reduces the amt of blood in the veins returning to the heart. Method: place pt in Fowlers to increase pooling in legs
How does decreasing afterload help with HF? Decreasing afterload (the amt of resistance against which the heart has to pump) decreases the amt of work of the LV and increases CO. Method: vasodilators
Examples of diuretics Lasix, furosemide, spironolactone
Examples of vasodilators ACE inhibitors, Nitrates.
Examples of positive inotropes Digitalis, B-adregenic agonists, calcium sensitizers
ACE inhibitors vasodilators (-PRIL), lowers BP to make it easier for heart to pump
ARBs opens blood vessels for better blood flow, lowers BP which makes it easier for heart to pump. (similar to ACE inhibitors but w/o the dry cough). (-SARTAN)
Anti-arrythmics regulates heart rate and rhythm. Amiodarone, Procainamide, Sotolol
Beta Blockers some help heart beat more slowly and regularly, lowers BP, decreases heart workload. (-OLOL)
CCB make heart pump more effectively, slows and regulates heart beat, lowers BP
Digitalis makes heart beat more effectively, slows and regulates heart beat, lowers BP. Digoxin/Lanoxin
Diuretics lowers BP, helps body get rid of extra fluid, lowers blood volume
Lipid-lowering drugs lowers fat levels in body.
nitrate and nitrite drugs relaxes and widens blood vessles to prevent and relieve angina
Potassium drugs replace K that is lost with diuretics
Jugular vein cardiac clue distended when client is at 45 degree angle- hypovolemia, pericardial tamponade, constrictive pericarditis
3 areas of damage after a myocardial infarction Ischemia, Injury, Infarction
Ischemia of heart, and ECG viability may not be damaged as long as MI does not extend, and collateral circulation is able to compensate. Causes depressed ST segment
Injury of heart, and ECG next to infarct. Tissue is viable as long as circulation remains adequate. Increasing O2 may save this area from necrosis. Causes ST segment elevation.
Infarction of heart, and ECG O2 deprived, irreversible damage, cause Q wave on ECG.
Drugs that treat hypertension CCB, then back-ups are Beta blockers.
Labs for heparin PTT & APTT
Labs for coumadin/warfarin PT & INR
Cor Pulmonale is also known as right sided heart failure
Right sided heart failure symptoms fatigue, increased peripheral venous pressure, distended jugular veins, enlarged abdomen (ascites), enlarged liver and spleen, weight gain, dependent edema.
Preload, and when is it increased volume of blood in ventricles at the end of diastole (end diastolic pressure). It is INCREASED in hypervolemia, regurgitation of cardiac valves, heart failure
Afterload, and when is it increased The resistance the left ventricle must overcome to circulate blood. INCREASED in hypertension, vasoconstriction. Increased afterload = increased cardiac workload
Stage 1 HTN 140/90 or higher
Stage 2 HTN 160/100 or higher
Stage 3 HTN s180 OR d110, or both
Ischemic cardiac symptoms pain (constricting, burning, heavy); most often radiates to the left; brought on by exercise, stress, cold, after meals, housework, yardwork, sweating, pallor, dyspnea, palpitations.
Non-cardiac signs that mimic cardiac arrest knife-like, stabbing, does not radiate, pain after *commpletion* of exercise, relief with anti-inflammatory agents or antacids, or decreasing activity. Occurs with couging, eating, body position change.
Women's cardiac symptoms more subtle, dizziness, chronic fatigue, lower extremity edema worse in evening, heart flutters, nausea or upset stomach similar to GERD.
Men's cardiac symptoms more textbook, radiating pain, squeezing, constant or intermittent pain in chest, perspiration, nausea, SOB.
DVT symptoms no symptoms, unilateral edema of limb, erythema and temp of 100.4, tenderness.
superficial thrombosis symptoms palpable, firm cordlike vein, area is red and tender, warm, edema may or may not be present.
DASH diet recommends how many grams of sodium per day 1.5
Normal triglyceride levels 40-190
cardioversion Cardioversion is a medical procedure by which an abnormally fast heart rate or cardiac arrhythmia is converted to a normal rhythm, using electricity or drugs. Digoxin is used for cardioversion.
echocardiogram U/S of heart. Shows valves, size, ejection rate, etc. (ideal is 50% or more ejection rate)
Plavix anti-platelet drug
Anti-thrombolytics given if clot already formed, to dissolve a clot that has already formed that may be causing a heart attack
aPTT normal value; therapeutic value; critical value 30-45; therapeutic around 70; critical 90-100 risk of hemorrhage
INR therapeutic values 1.5-2.5, but depends on situation, up to value of 3 for serious cases.
PT therapeutic value 1.1- 2.2
Digoxin/Lanoxin - what it does, what to do before giving this med increases the squeeze, keeps heart beating slower. Always take apical pulse for one full minute before giving this drug.
paroxysmal Afib happens intermittently
Pts who are on Dig and ___ diuretics, lowers the K levels in the body, at risk for Dig toxicity. Before you call the doctor for dig toxicity,
Before you call the doctor for dig toxicity . . take apical pulse for one full minute.
Digoxin level 1 - 2, more than that risk for toxicity
Signs of Dig toxicity * Dizziness * Blurred vision or seeing yellow or green halos * Vomiting * Diarrhea * Irregular heartbeat * Difficulty breathing
Pt teaching for recognize s/s of strokes FAST: face symmetry; arms symmetry strength; speech/ smile; talk
Coumadin pt teaching Pt should NOT miss a dose of Coumadin. If missed, call Dr. Don't ever double a dose. Watch for s/s of bleeding including what you can't see-- abdominal distention, joints, pale skin and gums.
If a pt gains more than ___ call dr. 3 pounds in 2 days, or 5 pounds in a week, call doctor.
Dig often is prescribed along with Lasix and K
First line of defense with HF ACE inhibitors, diuretics, digoxin.
The following labs are elevated in response to MI BUN, BNP, CK-MB (right away), troponin (later), Hemoglobin, glucose, B-type natriuretic peptide (BNP)
trigylcerides should be less than 100
Pack Years #packs per day x years
ABI- ankle brachial index This test is done by measuring blood pressure at the ankle and in the arm while a person is at rest. Measurements are usually repeated at both sites after 5 minutes of walking on a treadmill. Used to predict the severity of PAD. A slight drop= PAD.
Hgb/Hct hemoglobin 15; hematocrit 45: Magic Number where action is taken is around 10/30; Hct is usually 3x the Hgb
platelets normal value 150-400
INR preferred value 1.5- 3.5 (normal is 1)
PT value: therapeutic 70
coumadin given at 5 PM why does not mix with other drugs!, also gives time to work for morning blood draws
PTT: normal, therapeautic, and bad normal 30-40; therapeutic 70-ish; (over 100 is BAD because they won't clot)
What is Lovenox SubQ: LOVENOX is an anticoagulant therapy indicated to help reduce the risk of developing DVT, or deep vein thrombosis, which may lead to pulmonary embolism (PE)
HTN drug of choice for African-Americans CCB
Created by: AmericanChai