Ch. 29-32
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| Mitral Valve Prolapse | few s/s except "mitral click", mitral valve leaflets balloon back into the atrium
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| Medical Mgmt for Mitral Valve Prolapse | eliminate caffeine/alcohol/smoking
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| Nsg Mgmt for Mitral Valve Prolapse | inherited, risk for endocarditis, no surgical tx
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| Mitral Regurgitation | blood flowing back into L atrium causing hypertrophy
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| S/S mitral regurgitation | high pitched systolic murmur blowing snd, dyspnea, fatigue, cough, crackles, S3, S4
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| Medical mgmt for Mitral regurgitation | rest, low Na diet, lasix, nitrate, ACE inhibitors, ARBs, beta blockers
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| 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
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| What heart dysrhythmia does most stenosis cause | Atrial fibrillation cause strain on atrium
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| Aortic regurgitation | back flow into L vent from aorta. hypertrophy of L vent so incr sys BP,
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| s/s aortic regurgitation or L vent failure | orthopnea, breathing issues, high pitched diat murmur, PP widens,
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| Medical mgmt for aortic regurgitation | rest, CCB, ACE inhibitors, hydralazine
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| Aortic Stenosis | narrowing bn L vent and aorta
amniodarone- beta blocker
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| Valvuloplasty(repair) Closed/open commissurotomy annuloplasty chordoplasty | closed-break stuck valve
open- open heart surgery
annul: ring, leaflet repair
chor: tighten chordae tendinaea
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| 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
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| 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
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| 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
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| 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
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| 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)
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| What drug helps body not reject transplant? | cyclosporine
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| 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
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| 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
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| s/s of infective endocarditis | fever, heart murmur, chills, malaise, wt. loss, Roth's spots(eye), Osler nodes(fingers), splinger hemm(fingernails)
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| nsg mgmt | get three sets of blood cultures,
need rest wtih ADL's, watch for emboli, oral hygiene
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| Myocarditis | cause: radiation, lead poison/lithium/cocaine/HIV
s/s: flulike
Nsg: sensitive to dig toxicity/use PAS hose
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| s/s of dig toxicity: | Dig: Incr squeeze, lower HR
dysrhythmias, anorexia, HA, N/V, green/yellow halo
If pulse <60, don't give
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| 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
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| Rheumatic Endocarditis | due throat culture for strep
nsg: finish antibiotics
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| 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)
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| preload | amt of blood presented to vent b4 systole determined by venous return to heart
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| what lowers preload | hypertrophic cardiomyopathy of vent, stiff fibrotic tiss after MI
All these incr press and load on heart so lead to HF
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| afterload | amt of resistance to ejection of blood from vent overcoming resistance. Incr will decr SV cause vent work harder
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| What affects afterload | diameter/stretch of vessels and open/competence of lunar valves
incr after: HTN, vasoconstriciton, stenosis..incr work of heart
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| contractility | force of contraction from condition of myocardium. Sympathetic stimulation incr and MI with damaged cells lower contractility. Lower afterload to lower contractility
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| Assess rt vent preload? L vent afterload? | R vent pre: measure jugular venous distention(JVD)
L vent after: MAP
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| CHF-congested Heart Failure? | fluid overload/not tissue perfusion so not enuf CO for body's needs, progressive
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| 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
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| 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
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| 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
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| Causes of HF | Cornoary art dis, cardiomyopathy, HTN, valvular disorders, renal disorders,
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| 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)
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| 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),
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| R sided heart failure s/s | dependent edema, hepatomegaly, ascites, wt gain
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| Diagnostic findings with HF | elevated BNP.
Normal: <100
suggestive HF: 100-300
mild HF: >300
moderate HF: >600
severe HF: >900
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| Pharm therapy for HF: Ace inhibitors? | ACE: for systolic HF, "prils", promote vasodilation/diuresis by decr after/preload, block angio I to II
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| how do ACE help with diuresis | decr secretion of aldosterone and stim kidney to release Na/h2o while retaining K.
SE: cough, hyperkalemia
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| Affects of ARBs | "sartans", block affect of angio II at receptor, decr bp, incr CO, if ACE give cough, give ARB
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| hydralazine/Isosorbide Dinitrate(nitrate) | venous dilation so lower amt of blood return to heart so lower preload
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| 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
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| diurectic | loop:lasix, hypoK
thiazide:HCTZ, hypoK
K-sparing:
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| Dig(Lanoxin) | incr force of contraction and slows conduction thru AV node, can see heart blocks, assess apical 1m,
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| CCB | Verapamil(Calan), nifedipine (Procardia), diltiazem (Cardizem), Amlodipine(Norvasc), Plendil....vasodilation, shades on not see SA node
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| cardiogenic shock | decr CO leads to inadequate tissue perfusion and initiation of shock usually caused by MI
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| Test for PE | D-dimer tests for pieces of clots in blood
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| How much volume of blood is in venous sys | 75% of blood
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| What is the most important factor in regulating blood flow of peripheral blood vessels | sympathetic (adrenergic) NS...vasoconstriction by norepi
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| intermittent claudication | muscle cramping in extremities wtih excercise adn relieved by rest in pt w/ arterial insuff.
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| color of skin | rubor: reddish-blue seen in 20 sec-2m after placed in dependent position, suggests art damage and can't constrict
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| 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
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| What does angiography show? | dx of occlusive arterial dis, aneurysm(abn dilation of vessel)
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| what is arteriosclerosis? atherosclerosis? | art:"hardening", thickened artioles/aa
ath: intima of lg aa of blocked w/ plaques, stenosis
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| Risk factors for atherosclerosis | smoking/diet/htn/dm/obesity/stress/elevated C-reactive protein/age/female
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| What is nsg intv for using hot water bottle to help dilate extremities? | put hot water bottle on abd cause reflex vasodilation in extremities
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| 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,
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| 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
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| Major cause of aneurysm? thoracic aortic aneu? Adb aortic aneu? | atherosclerosis
s/s: pain, unequal pupils, dx w/ chest xray/TEE(grafts), pulsing abd
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| Arterial Embolism? thrombosis? | emboli from thrombi as a result of atrial fibrillation
s/s: 6P's: pain/pallor/pulselessness/paresthesia/poikilothermia(coldness)/paralysis
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| 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
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| 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)
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| Phlebitis(inflammation of vein walls) can accompany thrombus |
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| 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
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| pharmacology for VTE | heparin, LMWH, coumadin, thrombolytic, thrombin inhibitor, Folndaparinux(prophylaxis)
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| 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
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| complications of heparin | hemorrhage, thrombcytopenia(decr in platelet count),
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| 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
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| varicose veins | abnormally dilated superficial vv cuased by incompetent valves
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| Cellulitis? | bacteria enter tissue w/ swelling, redness, pain, fever, chills, sweating
tx: antibiotics
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| HTN? | 140-160/90-100, leads to hypertrophy of L vent
tx: decr peripheral resis/blood volume/strength, rate of contraction
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| pharm for htn | 140-90: thiazide diuretic &/or ACE, ARB, BB, CCB?
>160/100: thiaz+ace/arb/bb/ccb
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| Understanding drugs thiazide diurectic? loop? K-Sparing? aldosterone blocking | l: vol depletion, blocks reabsorption of Na/Cl/h2o
Lasix, Bumex, demadex
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| 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
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| Aldosterone blocker: for MI and vent dysfx, hyperkalemia, spironalactone (aldactone), Inspra | Methyldopa- displaces norepi, good for pregnant
Clonidine: lower bp,
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| 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
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| 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)
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| hypertensive emergency? hypertensive urgency? | emer: 180-120
tx: vasodilators(nitropress)...
urg: nose bleeds, anxiety, HA
tx: BB, ACE inh
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