ch 51 cardiovascular disorders

Peripheral arterial disease

A chronic disorder in which partial or total arterial occlusion deprives the lower extremities of oxygen and nutrients. Tissue damage occurs below the level of the arterial occlusion. Atherosclerosis is the most common cause of peripheral arterial disease data collection: intermittent claudication (pain in the muscles resulting from an inadequate blood supply). Rest pain, characterized by numbness, burning, or aching in the distal portion of the lower extremiteis, which awakens the client at night and is relieved by placing the extremity in a dependent position. Lower back or buttock discomfort. Loss of hair and dry, scaly skin on the lower extremities. Thickened toenails. Cold and gray-blue skin in the lower extremities. Eelvational pallor and dependen rubor in the lower extremities. Decreased or absent peripheral pulses. Signs of arterial ulcer formation occurring on or btwn the toes or on the upper aspect of the foot that are characterized as painful.. BP measurements at the thigh, calf, and ankle are lower than the brachial pressure. (Normally BP readings in the thigh and calf are higher than those in the upper extremities)

implantable cardioverter defibrillator (ICD)

An ICd monitors cardiac rhythm and detects and terminates episodes of VT and VF. The ICD senses VT or VF and delivers 25 to 30J up to four times if necessary. an ICD is used in clients with episodes of spontaneous sustained VT or VF unrelated to an MI or in clients whose med therapy has been unsuccessful in controlling life threatening dysrhythmias. Transvenous electrode leads are placed in the right atrium and ventricle in contact with the endocardium. Leads are used for sensing, pacing, and delivery of cardioversioin or defibrilation. The generator is most commonly implanted in theleft pectoral regioin. reinforce client education: Instruct the basic functions of ICD. Know the rate cutoff of the ICD and the number of consecutive shocks that it will deliver. Wear, loose-fitting clothing over the ICD generator site. Avoid contact sports to prevent trauma to the ICD generator and lead wires. Report any fever, redness, swelling, or drainage from the insertion site. Report symptoms of fainting, nausea, weakness, blackouts, and rapid pulse rates to the HCP. During shock discharge, the client may feel faint or SOB. Instruct the client to sit or lie down if he or she feels a shock and to notify the hcp. Advise the client to maintain a log of the date, time, and activity preceding the shock, the symptoms preceding the shock,a nd post shock sensations. Instruct the client and family in how to access the emergency medical system. Encourage the family to learn CPR. Instruct client to avoid eelctromagnectic fields directly over the ICD b/c they can inactivate the device. INstruct the client to move away from a magnetic field immediately if beeping tones are heard, and notify the hcp. Keep an ICD identification card in the wallet and obtain and wear a Medic-Alert bracelet. Inform all hcps that an ICD has been inserted. Certain diagnostic tests, such as an MRI, and procedures suing diathermy or electrocautery interfere with ICD function. Advise the client of restrictions on activities such as driving and operating dangerous equipment

Sinus tachycardia

Atrial and ventricular rhythms are regular Atrial and ventricular rates are 100 to 180 beats/min Treatment depends on the cause; notify the RN

B-type natriuretic peptide (BNP)

BNP is released in response to atrial and ventricular stretch; serves as a marker for heart failure. BNP is released in response to atrial and ventricular stretch; serves as a marker for heart failure. BNP levels should be less than 100pg/mL. The higher the level, the more severe the heart failure

blood prssure control

Baroreceptors, also called pressoreceptors, are located in the walls of the aortic arch and carotid sinuses. Baroreceptors ae specialized nerve endings that are affected by changes in the arterial BP. Increases in arterial pressure stimulate baroreceptros, and the heart rate and arterial pressure decrease. Decreases in arterial pressure reduce stimulation of the baroreceptors, and vasoconstriction and anincrease in heart rate occur. Stretch receptors, located in teh vena cava and the right atrium, respond to pressure changes that affect circulatory blood volume. When the BP decreases as a rsult of hypovolemia, a sympathetic response occurs, causing an increased heart rate and blood vessel constriction. When the BP decreases as a result of hypovolemia, a sympathetic response occurs, causing an increased heart rate and blood vessel constriction. When the BP increases as a result of hypervolemia, an opposite effect occurs. Antidiuretic hormone (vasopressin) influences BP indirectly by regulating vascular volume. Increases in blood volume result in decreased antidiuretic hormone release, increasing diuresis, and decreasing blood volume and thus decreasing BP. Decreaases in blood volume result in increased antidiuretic hormone release. This promotes an increase in blood volume and thus BP. Renin, a potent vasoconsctrictor, causes the BP to increase Renin converts angiotensinogen to angiotensin 1. Angiotensin 1 is then converted to agiotensin 11 in the lungs. Angiotensin 11 stimulates the release of aldosterone, which promotes water and sodium retention by the kidneys. This actioin increases blood volume and BP.

premature ventricular contractions (PVCs)

Bigeminy: PVC every other hearbeat Trigeminy: PVC every third heartbeat QUadrigeminy: PVC every fourth heartbeat COuplet or pair: Two sequential PVCs Unifocal: Uniform upward or downward deflection; arising from the same ectopic focus multifocal: different shapes, with the impulse generation from different sites R-on-T phenomenon: PVC falls on the T wave of the preceding beat and may precipitate ventricular fibrillation

Buerger's disease (thromboangiitis obliterans)

Buerger's disease is an occlusive disease of the median and small arteries and veins. The distal upper and lowe rlimbs are affected most commonly.

cadiac enzymes

CK-MB (creatine kinase, myocardial muscle) an elevation in value indicates myocardial damage. An elevation occurs within 4-6 hours and peaks 18-24 hrs following ac acute ischemic attack. Normal value is 0% to 5% of total; total CK is 25 to 174 units/L.

highly sensitive C-reactice protein (hsCRP):

Detects an inflammatory process such as that associated with the development of atherothrombosis; a level less tahn 1 mg/dL is considered low risk, and a level over 3mg/dL places the client at risk for heart disease.

varicose veins

Distended, protruding veins that appear darkened and tortous are evident. Vein walls weaken and dilate,a nd valves become incompetent.

endocarditis

Endocarditis is an inflammation of the inner lining of the heart and valves. Occurs primarily in clients hwo are IV drug abusers, have had valve replacements, or have mitral valve prolapse or other structural defects. POrts of entry for the inecting organism in clude the oral cavity (especially if the client had a dental procedure in the preveious 3-6 months), infections (cutaneous, genitourinary, gastrintestinal, and systemic) and surgery of invasive procedures, including IV line placement

dilated cardiomyopathy signs and symptoms

Fatigue and weakness heart failure (left side) dysrhythmias or heart block systemic or pulmonary emboli S3 and S4 gallops Moderate to severe cardiomegaly

venous insufficiency interventions

For venous insufficiency, leg elevation is usually prescribed to assist with the return of the blood to the heart. Reinforce instructions to the client to avoid prolonged sitting or standing, constrictive clothing, or crossing legs when seated. Reinforce instructions to the client to elevate the legs for 10 to 20 minutes every few hours each day. Reinforce instructions to the client to elevate legs above the level o the heart when in bed. Reinforce instructions to the client in the use of an intermittent sequential pneumatic compression system, if prescribed. Instruct the ambulatory cient to apply the compression system twice daily for one hour in the morning and evening. Advise the client with an open ulcer that the compression system is applied over a dressing

types of aortic aneurysm

Fusiform: Diffuse dilatioin that invovles the entrie circumference of the arterial segment Saccular: Distinct localized outpouching of the artery wall Dissecting: Created when blood separates the layers of the artery wall, forming a cavity btwn them False (pseudoaneurysm) Pseudoaneursym occurs when the clot and connective tissue are outside the arterial wall. Pseudoaneurysm occurs as a result of vesselinjury or trauma to all three elayers of the arteroil wall

surgical procedures

PTCA to compress the plaque against the walls of the artery and dilate the vessel. Lasre angioplasty to vaporize the plaque. Atherectomy to remove the plaque from the artery vascular stent (bare metal or drug-eluting) to prevent the artery from closing and to prevent restenoss Coronary artery bypass graft to improve blood flow to the myocardial tissue that is at risk for ischemia or infarction b/c of the occluded artery

Trendelenburg's test

Place the client in a supine position with the legs elevated. When the client sits up, if varicosities are present, veins fill from the proximal end. Veins normally fill from the distal end.

purkinje fiber

Purkinje fibers are a diffuse network of conducting strands located beneath the ventricular endocardium. These fibers spread the wave of depolarization thru the ventricles. Purkinje fivers can act as the pacemaker with a rate btwn 20 and 40 beats/min when higher pacemakers (such as the snioatrial and atrioventricular nodes) fail.

Raynaud's disease

Raynaud's disease is vasospasm of the arterioles and arteries of the upper and lower extremities. Vasospasm causes constriction of the cutaneous vessesl. Attacks are intermittent and occur with exposure to cold or stress. Primarily affects fingers, toes, ears, and cheeks

buerger's disease interventions

Reinforce instructions to the client to stop smoking, monitor pulses, reinforce instructions to the client to avoid injury to the upper and lower extremities, administer vasodilators as prescribed, reinforce instructions to the client regarding med therapy.

venous thrombosis

Thrombus can be associated with an inflammatory process. When a thrombus develops, inflamamtion occurs, thickening the vein wall and leading to embolization

ventricular tachycardia (VT)

VT occurs b/c of a repetitive firing of an irritable ventricular ectopic focus at a rate of 140 to 250 beats/min or more and ca lead to cardiac arrest. NOtify RN if VT occurs. A stable client with sustained VT (with pulse adn no signs of symptoms of decreased cardiac output_ will be treated with oxygen and antidysrhythmics. An unstable client with VT (with pulse and signs and symptoms of decreased cardiac output_ will be treated with oxygen and antidysrhythmics and possible synchronized cardioversion. The hcp may attempt cough cardiopulmonray resuscitaiton (CPR) by asking the client to cough hard every 1 to 3 secs. A pulseless client with VT will be treated with defibrillation and CPR.

spikes

When a pacing sitmulus is delivered to the heart, a spike (straight vertical line) is seen on the monitor or electrocardiogram stirp. spikes precede the chamber being paced. A spike preceding a P wave indicates that the atrium is being paced, and a spike preceding the QRS indicates the ventricle is being paced. An atrial spike followed by a P wave indicates atrial dpolarization, and a ventricular spike followed by a QRS represents ventricular depolarization. This is referred to as "capture" IF the electrode is in the atrium, the spike is before the P wave; if the electrode is in the ventricle, the spike is before the QRS complex.

heart transplant

a donor heart from an individual with a comparable body weight and ABO compatibility is transplanted into a recipient within 6hrs of procurement. The surgeon removes the diseased heart, leaving the posterior portion of the atria to serve as an anchor for the new heart. B/c a remnant of the client's atria remains, two unrelated Pwaves are noted on the electrocardogram. The transplanted heart is denervated and unresponsive to vagal stimulation. B/c the heart is denervated, clients do not experience angina. Symptoms of heart rejection include hyotension, dysrhythmias, weakness, fatigue, and dizziness. Endomyocardial biopsies are performed at regular scheduled intervals and whenever rejection is suspected. The client requires lifetime immunosuppressive therapy. Strict aseptic technique and bigilant hand washing must be maintained when caring for the posttransplant client b/c of increased risk for infection from immunosuppression. The heart rate approximates 100beats/min and responds slowly toe xercise or stress with regard toincreases in hear rate, contractility, and cardiac output.

hypertensive crisis

a hypertensive crisis is any clinical condition requiring immediate reduction in BP. A hypertensive crisis is an acute and life-threatening condition. Teh accelerated htn requires emergency treatmeht b/c target organ damage (brain, heart, kidneys, retina of the eye) can occur quickly. Death can be caused by stroke, kidney failure, or cardiac disease

laser-assited angioplasty

a laser probe is advanced thru a cannula similar to that used for PTCA. laser-assisted angioplasty is also used for clients with small angioplasty is also used for clients with small occlusionns in the distal superficial femoral, proximal popliteal, and common iliac arteries, and in the coronary arteries. Heat from teh laser vaporizes the plaque to open the occluded artery. preprocedure and postprocedure interventioins. Care is similar to that for PTCa. Monitor for complications of coronary dissection, acute occlusion, perforation, embolism, and myocardial infarction.

Hypomagnesimia

a low magnesium level can cause ventricular tachycardia (VT) and fibrillation. Electrocardiographic changes may be observed with hypomagnesemia include tall T waves and depressed ST segments

cardiac taymponade

a pericardial effusion occurs when the space btwn the parietal and visceral layers of the pericardium fills with fluid. Prericardial effusion places the client at risk for cardiac tamponade, an accumulation of fluid in the pericardial cavity. Tamponade restricts ventricular filling, and cardiac output dropls. Distant, muffled heart sounds are heard. Acute tamponade occurs when a small volume (20 to 50mL) of lfuid accumulates quickly in the pericardium

Microalbuminuria

a smalla mount of protein in the urine has been a marker for endothelial dysfunction in cardiovacular disease

sclerotherapy

a solution is injected into the vein, followed by the application of a pressure dressing. An incision and drainage of the trapped blood in teh scerosed vein are performed 14 to 21 days after the injection, followed by the application of a pressure dressing for 12 to 18 hrs

cardiomyopathy

a subacute or chronic disorder of the heart muscle. Treatment is palliative, not curative, and the client needs to deal with numerous lifestyle changes and a shortened life span. Types, signs and symptoms, and treatment

pacemakers settings

a synchronous (demand) pacemaker senses the client's rhythm and paces only if the client's intrinsic rate falls below the set pacemaker rate to stimulate depolarization. An asynchronous (fixed rate) pacemaker pacesa t a preset rate regardless of the client's intrinsic rhythm and is sued when the client is asystolic or profoundly bradycardic. Overdrive pacing suppresses the underlying rhythm in tachydysrhythmias so that the sinus node will regain control of the heart.

pacemakers

a temporary or permanent device that provides electrical stimulation and maintains the heart rate when the client's intrinsic pacemaker fails to provide a perfusing rhythm

thoracic aneurysm repair

a thoracotomy or median sternotomy approach is used to enter the thoracic cavity. The aneurysm is exposed and excised, and a graft or prosthesis is sewn onto the aorta. Total cardiopulmonary bypass is ncessary for excision of aneurysms in the ascending aorta. partial cadiopulmonary bypass is used for clients witha na aneurysm in the descending aorta.

thrombophlebitis

a thrombus associated with inflammation

phlebothrombosis

a thrombus without inflammation

cardiac tamponade

acute cardiac tamponade can occur when small volumes (20 to 50mL) of fluid accumulate rapidly in the pericardium

myocarditis

acute or chronic inflammation of myocardium as a result of pericarditis, a systemic infection, or allergic response

pericarditis

acute or chronic inflammation of the pericardium chronic pericarditis; a chronic inflammatory thickening of the pericardium, constricts the heart, causing compression. The pericardial sac becomes inflamed. Pericarditis can result in loss of pericaridal elasticity or an accumulation of fluid within the sac. heart failure or cardiac tamponade may result

right sided and left heart sided failure

acute pulmonary edema: severe dyspnea and orthopnea, pallor, tachycarida, expectoration of large amounts of blood tinged frothy sputum, wheezing and crackles on auscultation, bubbling respirations, acute anxiety, apprehension, restlessness, profuse sweating, cold clammy skin, cyanosis, nasal flaring, use of accessory breathing muscles, tachypnea, hypocapnia (evidenced by muscle cramps, weakness, dizziness, paresthesias)

client instructions after valve replacement

adequate rest is important, and fatigue is common. Anticoagulant therapy is necessary if a mechanical prosthetic valve was inserted. INstruct the client concerning hazards related to anticoagulant therapy and to notify the hcp if bleeding or excessive bruising occurs. INstruct the client concerning the importance of good oral hygiene to to reducte the risk of infective endocarditis. Brush teeth twice daily with a soft toothbrush, followed by oral rinses. Avoid irrigation devices, electric tooth brushes, and flossing b/c these activities can cause the gums to bleed, allowing bacteria to enter the mucous membranes and bloodstream. MOnitor incision and report andy drainage or redness. Avoid any dental procedures for six months. Heavy lifting (greater than ten lb) is to be avoided, and be cautions when in an automobile to prevent injury to the sternal incision. If a prosthetic valve was inserted, a soft audible clicking sound may be heard. Instruct the client concerning the importance of prophylatci antiobitcs before any invasive procedure and the importance of informing all HCPs of the avalvular disease history. Obtain and wear a Medi-Alert bracelet.

aortic aneurysms pharmacological interventions

administer antihypertensives to maintain the BP within normal limits and prevent strain on the aneurysm. Reinforce instructions to the client on the purpose of the meds. Reinforce instructions to teh client about the side effects and schedule of the meds

variant angina

also called Prinzmetal's or vasospastic angina. Results from coronary artery spasm. may occur at rest; attacks may be associated with ST segment elevation noted on the eelctrocardiogram. Intractable angina is a chronic, incapacitating angina that is unresponsive to interventions

unstable angina

also called preinfarction angina. Occurs with an unpredicatable degree of exertion or emotion and increases in occurrence, duration, and severity over time. Pain may not be relieved with nitroglycerin.

blood glucose

an acute cardiac episode can elevate the blood glucose level

aortic aneurysms

an aortic aneurysm is an abnormal dilation of the arterial wall caused by localized weakness and stretching in the medial layer or wall of the aorta. The aneurysm can be located anywhere along the abdominal aorta. The goal of treatment is to limit the progression of the disease by modifying risk factors, controling the BP to prevent strain on the aneurysm, recognizing symptoms early, and preventing rupture

automatic external defibrillator

an automatic eernal defibrillator is sued by laypersons and emergency medical technicians for prehospital cardiac arrest. Place the client on a firm, dry surface. Stop CPR. Ensure that no one is touching the client to avoid motion artifact during rhthm analysis. Place the electrode patches in the correct position on the client's chest. Press the analyzer button to identify the rhythm, which may take 30 seconds. The machine will advise whether a shock is necessary. Shocks are recommended for pulseless VT or VF only.

white blood cell count

an elevated WBC of 10-20K cell/mm3 appears on the second day after the MI and lasts up to one week

hypertensive crisis data collection

an extremely high Bp and usually diastolic pressure is greater than 120mm Hg headach drowsiness and confusion, blurred vision, changes in neurological status, tachycardia, tachypnea, dyspnea, cyanoisis, seizures

blood coagulation factors:

an increase in coagulation factors coagulation factors can occur during and after MI, which places the client at greter risk of thrombophlebitis and extension of clots in the coronary arteries.

percutaneous transluminal coronary angioplasty (PTCA)

an invasive , nonsurgical technique in which one or more arteries are dilated with a balloon catheter to open the vessel lumen and improve arterial blood flow. PTCA may be used for clients with an evolving MI alone, or in combination with meds to achieve reperfusion. The client can experience reocclusion after the procedure; thus the procedure may need to be repeated. Complications can include arterial dissection or rupture, emobilization of plaque fragments, spasm, and acute MI. A firm commitment is needed on the part of the client to sop smoking, adhere to dietary restrictions, lose wieght, alter exercise patterns, and stop any behaviors that could lead to the progression of artery occlusion. Preprocedure interventions: Maintain NPO status after midnight. Obtain informed consetn and allergy assessment to iodine, and withhold metformin (as for cardiac catheterization) Prepared the groin area with antiseptic soap and shave per institutional procedure and as prescribed. Monitor baseline vitals and peripheral pulses. Reinforce instructions to the client that chest pain may occur during balloon inflation and to report it if it does occur. postprocedure interventions: monitor vitals closely. Check distal pulses in both extremities. Maintain bed rest as prescribed, keeping the lim straight for 6 to 8 hrs. Administer anticoagulants such as IV heaprain and antiplatelet agents as prescribed to prevent thrombus formationi. Intravenous nitroglycerin may be prescribed to prevent coronary artery vasospasm. Encourage fluids if not contraindicated to enhance renal excretion of dey. Reinforce instructions to the client in the administration of nitrates, calcium channel blockers, antiplatelet agents , and anticoagulants as prescribed. Reinforce instructions to the client to take acetylsalicycli acid (aspirin) daily permanently if prescribed. Assit the client with planning lifestyle modifications

electrophysiologic studeis

an invasive procedure in which a programmed electricalstimulation of the heart is induced to cause dysrhythmias and conduction defects, assists in finding an accurate diagnosis and aids in determining reatment

cardiac catheterization

an invasive test involving insertion of a catheter into the heart and surrounding vessels Obtains info about the structure and performance of the heart chambers and valve and the coronary circulation preprocedure interventions: obtain informed consetn; monitor for allergies to seafood, iodine, or radiopaque dyes. If allergic, the client may be premedicated with antihistamines and corticosteroids to prevent a reaction. Withhold solid food for 6-8 hrs and liquids for 4 hrs as prescribed to prevent vomiting and aspiration during the procedure. Document the client's height and weight b/c these data will be needed to determine the amount of dye to be administered. Document baseline vitals and note the quality and presence of peripheral pulses for postprocedure comparision. Inform the client that a local anesthetic will be adminsitered before catheter insertion. INform the client that he or she may feel fatigued b/c of the need to lie still and quiet on a hard table for up to 2 hrs. Inform the client that he or she may feel a fluttery feeling as the catheter passes thru the heart; a flushed, warm feeling when the dye is injected; a desire to cough; and palpitations caused by heart irritability. prepare the insertion site by shaving and cleaning with an antiseptic solution, if prescribed. Administer preprocedure meds such as sedatives, if prescribed. Insert an IV line, if prescribed. If a client taking metformin (Glucophage ) is chedule to undergo a procedure requiring the amdinistration of iodine dye, the metformin is withheld 24 to 48 hrs (as prescribed) prior b/c of the risk of lactic acidosis. The med is not resumed until directed to do so by the hcp (usually 48 hrs after the procedure of after renal function studies are done and the results are evalauted) postprocedure interventions: monitor vitals and cardiac rhythm for dyrhythmias at least every 30 minutes for 2 hrs initially. Monitor for chest pain. IF dysrhythmias or chest pain occurs, notify the hcp. Monitor peripheral pulses and the color, warmth, and sensation of the extremity distal to the insertion site at least every 30 minutes for 2 hrs initially. NOtify the hcp if the client complains fo numbness and tingling; the extremity becomes cool, pale, or cyanotic; or loss of the peripheral pulses occurs monitor the pressure dressing for bleeding or hematoma formation; apply a sandbag or compression device to the insertion site to provide additional pressure is prescribed. Monitor for bleeding. If bleeding occurs, apply manual pressure immediately and notify the hcp. MOnitor for hematoma. If a hematoma develops, notify the hcp. keep extremity extenxed for four to six hrs, as prescribed, keeping the leg straight to prevent arterial occlusion. Maintain strict bed rest for six to twelve hrs, as prescribed;howerver, the client may turn from side to side. Do not elevate the head of the bed more than 15 degrees. If the antecubital vessel was used, immobilize the arm with an armboard. Encourage fluid intake, if not contraindicated, to promote renal excretion of the dye and replace fluid loss caused by the osmotic diuretic effect of the dye. Monitor for nausea, vomiting, rash, or other signs of hypersensitivity to the dye. Do not resume the administration of metformin (Glucophage) until directed by the hcp (usually 48 hrs after catheterization)

myoglobin

an oxygen-binding protein found in cardiac and skeletal muscle. The level rises within 1 hour after cell death, peaks in 4 to 6 hours, and returns to normal within 24 to 36 hours (even faster in some clients)

angina

angina is chest pain resulting form myocardial ischemia caused by inadequate myocardial blood and oxygen supply. Angina is caused by an imbalance btwn oxygen supply and demand. Causes include obstruction of coronary blood flow b/c of atherosclerosis, coronary artery spasm, and conditions increasing myocardial oxygen consumption. The goal of treatment forangina is to provide releif of the acute attack, correct the imbalance btwn myocardial oxygen supply and demand, and prevent the progression of the disease and further attacks to reduce the risk of MI.

aortic valve disorders

aortic stenosis and aortic insufficiency

invasive epicardial pacing

applied by using a transthoracic approach. The lead wires are threaded loosely on the epicardial surface of the heart after cardiac surgery.

use of paddle electrodes

apply conductive pads. One paddle is placed at the third intercostral space to the right of the sternum; the other is placed at the fifth intercostal space on the left midaxillary line. Apply firm pressure of at least 25lb to each of the paddles. Be sure that no one is touching the bed or the client when delivering the countershock. Pads for hands-off biphasic defibrillation may be applied in an anterior-posterior position or apex-posterior position, and placement direcly over breast tissue should be avoided.

venous insufficiency meds

apply topical agents to the wound as prescribed to debride the ulcer, eliminate necrotic tissue, and promote healing. When applying topical agents, apply an oil-based agent such as petroleum jelly (Vaseline) on surrounding skin, b/c debriding agents can injure healthy tissue. Administer antibiotics as prescribed if infection or cellulitis occurs

the vascular system

arteries are vessels thru which the blood passes away from the heart to various parts of the body. They convey highlyoxygenated blood from the left side of the heart to the tissues. Arterioles control the blood flo into the capillaries. Capillaries allow the exchange of fluid and nutrients btwn the blood and the interstitial spaces. Venules receive blood from the capillary bed and move blood into the veins. Veins transport deoxygenated blood form the tissues back to the right heart and then the lungs for oxygenation. Valves help return blood to the heart agains the force of gravity. The lymphatics drain the tissues and return the tissue fluid to the flood

myocarditis interventions

assist the client to aposition of comfort such as sitting up and leaning forward. Adminster analgesics, salicylates, and nonsteroidal anti-inflammatory drugs a s prescribed ot reduce fever and pain. Administer oxygen as prescribed. Provide adequate rest periods. LImit activities to avoid overexertion and to decrease the workload of the heart. Administer digoxin (Lanoxin) as prescribed, and monitor for signs of digoxin toxicity. Adminster antidysrhythmics as prescreibed. Administer antibiotics as prescribed to treat the causative organism. Monitor for complications, which can include thrombus, heart failure, or cardiomyopathy

Trendelenburg's test interventions

assit with Trendelenburg's test. Reinforce instructions to the client to elevate the legs as much as possible. Reinforce instructions to the client to avoid constrictive clothing and pressure on the legs. Prepare the client for sclerotherapy or vein stripping as prescribed.

pulmonary stenosis

asymptomatic in a mild condition, dyspnea, fatigue, syncope, signs of right ventricular failure including ascites, hepatomegaly, peripheral edema, systolic thrill heard at left sternal border interventions: refer to section on repair procedures, prep the client for pulmonary valve commissurotomy as indicated

pulmonary insufficiency

asymptomatic in mild condition, dyspnea, fatigue, syncope, signs of right ventricular failure including ascites, hepatomegaly, peripheral edema, systolic thrill heard at the left sternal border interventions: refer to section on repair procedures, prep client for valve replacement as indicated

tricuspid insufficiency

asymptomatic in mild situations, signs of right ventricular failure including ascites, hepatomegaly, peripheral edeam, pleural effusion, systolic murmur heard at the left sternal border, fourth intercostal space

atherectomy

atherectomy removes plque from acoronary artery by the use of a cutting chamber on the inserted catheter or a rotating blade that pulverizes the plaque. Atherectomy is also used to improve blood flow to ischemic limbs in individuals with peripheral arterial disease preprocedure and postprocedure interventions: care is similar to that for PTCA. Monitor for complications of perforation, embolus, and reocclusion.

sinus bradycardia

atrial and ventricular rates are regular and are less than 60 beats per min note that a low heart rate may be normal for some individuals. treatment may be necessary if the client is symptomatic (signs of decreased cardiac output) Treatment depends on the cause and may include holding a med, oxygen, atropine sulfate, or a pacemaker; notify the RN

right ventricle failure/left ventricular failure

b/c two ventricles of the heart represent two separate pumpting systems, it is possible for one to fail alone for a short period. Most heart failure begins with left ventricular failure and progresses to failure of both ventricles. Acute pulmonary edema-a medical emergency-results from left ventricular failure. If pulmonary edema is not treated, death will occur from suffocation b/c the client literally drowns in his or her own fluids.

valvular heart diseae repair procedures

balloon valvuloplasty: balloon valvuloplasty is an invasive, nonsurgical procedure. a balloon catheter is passed from the fremoral vein thru the atrial septurm to the mitral valve or thu the femoral artey to the aortic valve. The balloon is inflated to enlarge the orifice. Institute precautions for arterial punctrue if appropriate. Monitor for bleeding from the catheter insertion site. Monitor for signs of systemic emboli. Monitor for signs of regurgitant valve by monitoring cardiac rhythm, heart sounds, and cardiac output.

arterial disorders interventions

because swelling in the extremities prevents arterial blood flow, the client with peripheral arterial disease is instructed to elevate the feet at rest but to refrain from elevating them above the level of the heart b/c extreme elevation slows arterial blood flow to the feet. In severe cases of peripheral arterial disease, clients with edema may sleep with affected limb hanging from the bed, or they may sit upright (without leg elevation) in a chair for comfort. monitor for pain, monitor extremities for color, motion, sensation, pulses. Obtain BP measurements. Monitor for signs of ulcer formation or signs of gangrene. Assit in developing an individualized exercise program, which is initiated gradually and slowly increased. Encourage prescribed exercise, which will improve arterial flow thru the development of collateral circulation. Reinforce instructions to the client to walk to the point of claudication, stop and rest, and then walk a little farther. Reinforce instructions to the client with peripheral arterial disease to avoid crossing the legs, which interferes with blood flow. Reinforce instructions to the client to avoid exposure to cold(causes vasoconstriction) to the extremities and to wear socks or insulated shoes for warmth at all times. Reinforces instructions to teh client never to apply direct heat to the limb, such as with a heating pad or hot water, b/c the decreased sensitivity in the limb will cause burning. Reinforce instructions to the client to inspect the skin on the extremities daily and report any signs of skin breakdown. Reinforce instructions to the client to avoid tobacco and caffeine b/c of their vasoconstrictive effects. Reinforce instructoiins to the client in the use of hemorheologic and antiplatelet meds as prescribed. Inform the client of the importance of taking all meds prescribed by the HCP. Procedures to improve arterial blood flow: percutaneous transluminal angioplasty with or without intravascular stent; laser-assisted angioplasty; atherectomy; bypass surgery: (inflow procedures bypass the occlusion above the superficial femoral arteries and include aortoiliac, aortofemoral, and axillofemoral bypasses. Outflow procedures bypass the occlusion at or below the superficial femoral arteries and include femoropopliteal and femorotibial bypasses)

bioprosthetic valves

biological grafts are xenografts (valves from other species) : porcine valves; bovine valves, or homografts (human cadavers). The risk of clot formation is small; therefore, long-term anticoagulation is not indicated.

raynauds disease data collection

blanching of the extreemity, followed by cyanosis during vasoconstriction. Reddened tissue when the vasospasm is relieved. Numbness, tingling, swelling, and a cold temp at the affected body part

blood lipid levels

blood lipid levels may be elevated. Cholesterol-lowering meds may be prescribed to reduce the development of atherosclerotic plaques inteventions: reinforce instructions to the client regarding the purpose of diagnostic medical and surgical procedures and the preprocedure and postprocedure expectations. assit the client to identify risk factors that can be modified. Assit the client to set goals to promote lifestyle changes that will reduce the impact of risk factors. Assist the client to identify barriers to compliance with the therapeutic plan and to identify methods to overcome barriers. Reinforce instructions to the client regarding a low-calorie, low-sodium, low-cholesterol, and low-fat diet, with an increase in dietary fiber. Stress to the client that dietary changes are not temporary and must be maintained for life. Teach the client about prescribed meds. Provide community resources to the client regarding exercise, smoking reduction, and stress reduction as appropriate.

deep vein thrombophlebitis--

calf or groin tenderness or pian with or without swelling positive Homan' signs may be noted; however, false-positive results are common so this is not a reliable measure warm skin that is tender to touch

hypercalcemia

can cause a shortened ST segment and widened T wvae, AV block, tachycardia or bradycardia, digitalis hypersensitivity, and cardiac arrest.

angina---

can develop slowly or quickly; usually describ3ed as mild or moderate pain; substernal; crushing; squeezing pain; may radiate to the shoulders and arms and jaw and neck and back usually lasts less than five minutes; however, can last up to 15- 20 minutes relieved by nitroglycerin or rest

cardioversion

cardioversion is synchronized coutershock to convert an undesirable rhythm to a stable rhythm. Cardioversion can be an elective procedure performed by the hcp for stable tachydysrhythmias resistant to medical therapies or an emergent procedure for hemodynamically unstable ventricular or supraventricular tachydysrhthmias. A lower amount of energy is used than with defibrillation. Defibrillator is synchronized to the client's R wave to avoid discharging the shock during the vulnerable period (T wave) If the defibrillator were not synchronized, it could discharge on the Twave and cause VF.

coronary artery stents preprocedure and postporcedure interventions

care is similar to that for PTCA. acute thrombosis is a major concern following the procedure, and the client is place don atiplatelet therapy such as clopidogrel (Plavix) and aspirin for several months after the procedure. Length of time of antiplatelet therapy is determined by the type of stent that has been deployed. Monitor for complications of the procedure such as stent migration or occlusion, coronary artery dissection, and bleeding resulting from anticoagulation

cardiac catheterization--

catheterization provides a definitive diagnosis by providing information about the patency of the coronary arteries

hyperkalemia

causes asystole and ventricular dysrhythmias. Teh electrocardiogram may show tall peaked T waves, widened QRS complexes, prolonged PR interveals, or flat Pwaves

hypokalemia

causes increased cardiac electrical instability, ventricular dysrhythmias, and increased risk of digoxin toxicity inhypokalemia the electrocardiogram would show flattening and inversion of the Twave, the apperance of a U wave, and ST depression

ventricular fibrillation (VF)

chaotic rapid rhythm in which the ventricles quiver and there is no cardiac output. Client lacks a pulse, BP, respirations, and heart sounds, and VF is fatal if not successfully terminated within 3 to 5 minutes. Tretment includes CPR and immediate defibrillation

aortic aneuriysms preop interventions

check all peripheral pulses as a baseline for postoper comparison. Instruct client on coughin and deep breathing exercises. Adminster bowel preop as prescribed

stress test

chest pain or changes in the electrocardiogram or vitals during testing may indicate ischemia

compensatory mechanisms

compensatory mechanisms act to restore cardiac output to near-normal levels. Initially these mechanisms increase cardiac output; however, they eventually have a damaging effect on pump action. Compensatory mechanisms contribute to an increase in myocardial oxygen consumption; when thsi occurs, yocardial reserve is exhausted and clinical manifestations of heart failure develop. Compensatory mechanisms include increased heart rate, improved stroke volume, arterial vasoconstriction, sodium and water retention, and myocardial hypertrophy. Signs of left ventricular failure are evident in the pulmonary system. Signs of right ventricular failure are evident in the systemic circulation

troponin

composed of three proteins: troponin C, cardiac toponin I, and cardiac troponin T

bioprostehtic valves preoperative interventions:

consult with the HCP regarding discontinuing anticoagulants 72 hrs before surgery.

bundle of his

continuation of the AV node and located at the interventricular septum. It branches into the right bundle branch, which extends down the right side of the interventricula rseptum, and the left bundle branch, which extends into the left ventricle. The right and left bundle branches terminate into Purkinje fibers.

coronary artery disease

coronary artery disease is a narrowing or obstruction of one or more coronary arteries as a result of atherosclerosis, an accumulaiton of lipid-containing plaque in the arteries. The disease causes decreased perfusioin of myocardial tissue and inadequate myocardial oxygen supply, leading to htn, agina, dysrhythmias, MI, heart failure, and death. Collateral circulation, more than on artery supplying a muscle with blood, is normally present in the coronary artereis, especially in older persons. The development of collateral circulation takes time and develops wehn chronic ischemia occurs to meet the metabolic demands. Therefore an occlusion of a coronary artery in a younge rindividual is more likely to be lethal than in an older individual. Symptoms occur when the coronary artery is occluded to the point that inadequate blood supply to the muscle occurs, causing ischemia. Coronary artery narrowing is significant if the lumen diamter of the left main artery is reduced at least 50%, or any major branch is reduced at least 75%. The goal of treatment is to alter the atherosclerotic progression. data collection: possibly normal findings during asymptomatic periods; chest pain; palpitations; dyspnea; syncope; cough or hemoptysis; excessive fatigue

coronary artery stents

coronary artery stents (usually bare metal or drug-eluting) are used in conjunction with PTCA to provide a supportive scaffold to eliminate the risk of acute coronary vessel closure and improve long-term patency of the vessel. a balloon catheter bearing the stent is inserted into the coronary artery and positioned at the site of occlusion. Ballon inflation dploys the stent. When placed in the coronary artery, teh stent reopens the blocked artery.

right sided heart failure

dependent edema (legs and sacrum) jugular venous distention, abdominal distentioin, hepatomegaly, splenomegaly, anorexia, nausea, weight gain, nocturnal diuresis, swelling of fingers and hands, increased BP (from fluid volume excess) or decreased BP (from pump failure)

pericarditis interventions

derermine the nature of the pain. Position the client in the high Fowler's positioin, or upright and leaning forward. Administer analgesics, nsaids, or corticosteroids for pain as precribed. Administer diuretics and digoxin (Lanoxin) as prescribed to the client with chronic constrictive pericarditis. Surgical incision of the pericardium (pericardiectomy) may be necessary. Monitor for signs of cardiac tamponade, which include pulsus paradoxus, jugular vein distention with clear lung sounds, muffled heart sounds, narrowed pulse pressure, tachycardia, and decreased cariac output. Notify the hcp if signs of caridac tamponade occr.

client education for htn

descrie the importance of compliance with the treatment plan. Describe teh disease process, explaining the symptoms usually do not develop until organs have suffered damage. Initiate and assit the client in planning a regular exercise progarm, avoiding heavy weight lifting and isometric exercises. Emphasize the importance of beginning the exercise program gradually. Encourage the client to express feelings about daily stress. Assist the client to identify ways to reduce stress. Teach relaxation techniques. Instruct the client on how to incorporate relaxation techniques into the daily living pattern. INstruct the client to maintain a dairy of blood pressure readings. Emphasize the imprtance of lifelong med and the need for follow up treatment. Instruct the client and family abouit the dietariy restrictions which may include sodium, fat, ccaloreis, and cholesterol. Instruct the client on how to shop for and prepare low-sodium meals. Provide alist of products that contain sodium. Instruct the client to read labels of products to determine sodium content, focusing on substances listed as sodium, NaCL, or MSG (monosodium glutamate). Instruct client to bake, roast, or boil foods. Avoid salt in prep of foods, and avoid using salt at the table. Instruct that fresh foos are best to consume and to avoid canned foods. Insruct about actions, side effects, and scheduling of meds. Advise that if uncomfortable side effects occur to contact the HCP and not to stop the med. Instruct the client to avoid over the counter meds. Stress theimportance of follow up care.

electronic beam computer tomography scan (EBCT)

determines whether calcifications are present in the arteries; coronary artery calcium (CAC score is provided (a score higher than 400 requires intensive preventive treatment)

diagnostic tests

diagnostic tests are done to confirm the presence, size and location of the aneurysm testws include abdominal ultrasound, computed tomography scan, and arteriography

restrictive cardiomyopathy signs and symptoms

dyspnea , fatigue, heart failure (right sided), mild to moderate cardiomegaly S3 and S4 gallops heart block emboli

aortic stenosis

dyspnea on exertion, angina, syncope on exertion, fatigue, orthopnea, paroxysmal noctural dyspnea, harsh systolic crescendo-decrescendo murmur interventions: refer to section on repair procedures prep client for valve replacement as indicated

nonobstructed cardiomyopathy signs and symptoms

dyspnea, angina, fatigue, syncope, palpitations, mild cardiomegaly, S4 gallop, ventricular, dysrhythmias, sudden death common, heart failure

aortic insufficiency

dyspnea, angina, tachycardia, fatigue, orthopnea, pareoxysmal nocturnal dyspnea, blowing decrescendo diastolic murmur

complications of myocardial infarction

dysrhythmias, heart failure, pulmonary edema, cardiogenic shock, thrombophlebitis, pericarditis, mitral valve insufficiency, postinfarction angina, ventricular rupture, dressler's syndrome (a combination of pericarditis, pericardial effusion, pleural effusion, which can occur several weeks to several months after a myocardial infarction

premature ventricular contractions (PVCs)..

early venticular complexes result from increased irritability of the ventricles Treatment depends on the cause, and the RN is notified if PVCs occur For the client experiencing PVCs, notify the hcp if client complains of chest pain or fi the PVCs increase in frequency, are multifocal, occur on the Twave (R on T), or occur in runs of ventricular tachycardia.

tricuspid steosis

easily fatigued, effort intolerance, complaints of fluttering sensations in the neck (obstructed venous flow), cyanosis, signs of right ventricular failure including ascites, hepatomegaly, peripheral edema, jugular vein distention with clear lung fields, symptoms of decreased cardiac output, rumbling diastolic murmur interventions: refer to section on repair procedures and prep the client for valve replacement as indicated

electrocardiogram

elecrocardiogram shows eith ST eelvation MI (STEMI), T wave inversion, or non-ST elevation MI (NSTEMI); an abnormal W wave may also be present. Hours to days after, the MI, ST, and T wave changes will return to normal, but the Q wave usually remains permanently.

Homocysteine

elevated level may increase the risk of cardiovacular disease; level should be less than 14 mmol/dL.

pericardial sac

encases and protects the heart from trauma and infection. has two layers: the pareital pericardium is the tough, fibrous outer membrane that attaches anteriorly to the lower half of the sternum, posteriorly to the thoracic vertebrae, and inferiorly to the diagphragm. The visceral pericardium is the thin, inner layer that closely adheres to the heart. The pericardial space is btwn the parietal and visceral layers. It holds 5 to 20mL of pericardial fluid, lubricates the pericardial surfaces, and cushions the heart.

heart failure following acute episode

encourage client to verbalize feelings about the lifestyle changes rquired as a result of the heart failure. Assit the client to identify precipitating risk factors of heart failure and methods of eliminating these risk factors. Reiforce instructions to the client in the prscribed medication regimen, which may include digoxin (Lanoxin), a diuretic, angiotensin-converting enzyme (ACE) inhibitors, low-dose b-blockers, and vasodilators, angiotensin-converting enzyme (ACE) inhibitors, low-dose b-blockers, and vasodilators. Advise the client to notify the HCP if side effects occur from the meds. Advise the client to avoid over-the-counter meds. Reinforce instructions to the client to contact the hcp if he or she is unable to take meds b/c of illness. Reinforce instructions to the client to avoid large amounts of caffeine, found in coffee, tea, cocoa, chocolate, and some carbonated beverages. Reinforce instructions to the client about the prescribed low-sodium, low-fat, and low-cholesterol diet. Provide the client with a list of potassium-rich foods b/c diuretics can cause hypokalemia (except for potassium-sparing diuretics) Reinforce instructions to the client regarding fluid restriction, if prescirbed, advising the client to spread the fluid out during the day and to suck on hard candy to reduce thirst. Reinforce instructions to the client to balance periods of activity and rest. Advise the client to avoid isometric activities, which increase pressure in the heart. Reinforce instructions to the client to monitor daily weight. Reinforce instructions to the client to report signs of cluid retention such as edema or weight gain

cardioversion during the procedure

ensure that the skin is clean and ry in the area where the electrode paddles/hands off pads will be placed. Stop the oxygen during the procedure to avoid the hazard of fire. Be sure that no one is touching the bed or the client when delivering the countershock.

diagnostic tests following the acute stage

exercise tolerance test or stress test may be prescribed to assess for electrocardiographic changes and ischemia and to evelaute for medical therapy or identify clients who may need invasive therapy. Thallium scans may be prescribed to assess for ishemia or necrotic muscle tissue. Multigated cardiac blood pool imagng scans may be used to evaluate left ventricular function. Cardiac catheterization is performed to determine the extent and locationof obstructions of the coronary arteries

cardiogenic shock

failure of the heart to pump adequately, thereby reducing cardiac output and compromising tissue perfusion. Necrosis of more than 40% of the left ventricle, usually as a result of occlusion of major coronary vessesl. Goal of treatment: to maintain tissue oxygenation and perfusion and improve the pumping ability of the heart.

coronary artery bypass preoperative interventions

familiarize the client and family with the cardiac surgical critical care unit. Inform the client to expect a sternal incision, possible arm or leg incision (s), one or two chest bues, a Foley catheter, and several IV fluid catheters. Inform the client that an endotracheal tube will be in place and that he or she will be unable to speak. Advise the client that he or she will be on mechanical ventilation and to breathe with the ventilator and not fight it. Reinforce instructions to the client to inform the nurse of any posoperative pain b/c pain meds will be available. Reinforce instructions to the client on how to splint the chest incision, cough and deep brethe, use the incentive spiromenter, and perform arm and leg exercises. Encourage the client and family to discuss anxieties and fears related to surgery. Note that prescribeds meds may be discontinued preoperatively (usually diuretics 2 to 3 days before surgery, digoxin 12 hours before surgery, and aspirin and anticoagulants 1 wk before surgery.) Administer meds as prescribed, which may include potassium chloried, antihypertensives, antidysrhythmics, and antibiotics

endocarditis data collection

fever, anorexia, weight losso, fatigue, cardiac murmurs, heart failure, embolic, complications from vegetation fragments traveling thru the circulation, petechiae, splinter hemorrhages in the nail beds, Oslers nodes (reddish tender lesions) on the pads of the fingers, hands, and toes Janeway lesions (nontender hemorrhagic lesions) on the fingers, toes, nose, or ear lobes Splenomegaly clubbing of the fingers

myocarditis data collection

fever, pericardial friction rub, a gallop rhythm, a murmur that sounds like fluid passing an obstruction, pulsus alternans, signs of heart failure, fatigue, dyspnea, tachycardia, chest pain

dilated cardiomyopathy

fibrosis of myocardium and endocardium dilated chambers mural wall thrombi prevalent

cardiac ensymes and troponins

findings are normal in angina

htn-

for an adult (aged 18 and older), a normal Bp is a systolic BP below 120mm HG and a diastolic below 80 mm Hg. An individual classified with prehypertension has a systolic BP btwn 120 and 139 mm Hg or a diastolic pressure btwn 80 and 89 mm Hg. Stage 1 htn can be classified as a syistolic Bp btwn 140 and 159 mm Hg or a diastolic pressure btwn 90 and 99 mm Hg stage 2 htn can be classified as a systolic Bp equal to or greater than 160mm Hg or a diastolic pressure equal to or greate tha 100mm Hg Hypertension is a major risk factor for coronary, cerebral, renal, and peripheral vacular disease. The disease is initially asymptomatic. The goals of treatment include reduction of the BP and preventing or lessening the extent of organ damage. Nonpharmacological approaches, such as lifestyle changes, may be prescribed initially; if the BP cannot be decreased after a reasonable priod (1 to 3 months), the client may require pharmacological tretment

secondary htn interventions

goals: one treatment goal is to reduce the BP. another treatment goal is to prevent or lessen the extent or organ damage. question the client regarding the signs and symptoms indicative of htn Obtain the BP two or more times on both arms with the client supine and standing. Compare the BP with prior documentation. Determine family history of htn. Identify curren tmed therapy. Obtain weight. Evaluate dietary patterns and sodium intake. Monitor for cardiovascular changes such as distended neck veins, increased heart rate, and dysrhythmias. Evaluate chest x-ray film for heart enlargment. Monitor neurological system. Evaluate renal function. Evaluate results of diagnostic and lab studies.

troponin I

has a high affinity for myocardial injury; it rises within 3 hours and persists for up to 7 to 10 days. normal values are low, with troponin I being lower than 0.6 ng/mL and troponin T normally ranging from 0 to 0.2ng/mL; thus any rise can indicate myocardial cell damage

nonobstructed cardiomyopathy

hypertrophy of the walls hypertrophied septum relatively small chamber size

hypocalcemia

hypocalcemia can cause vventricular dysrhythmias, prolonged ST and WT interval, and cardiac arrest.

forward failure/backward failure

in forward failure, an inadequate output of the affected ventricle causes decreased perfusion to vital organs. In backward failure, blood backs up behind the affected ventricle, causing increased pressure in the atrium behind the affected ventricle

low output/high output

in low-output failure, not enough cardiac ouput is available to meet the demands of the body. High-output failure occurs when a condition causes the heart to work harder to meet the demands of the body

holtermonitoring

in this noninvasive test, the client wears a Holter monitor, and ana elecrocardiographic tracing is recorded continuously over a period of 24 hrs or more whild the client performs his activiteis of daily living. The Holter monitor identifies dysrhthmias if they occur and evalautes the effectivenss of antidysrhythmics or pacemaker therapy. interventions: reinfoce instructions to the client to resume normal daily activities and to maintain a diary documenting activities and any symptoms that may develop for correlation to the electrocardiographic tracing. Reinforce instructions to the client to avoid tub baths or showerw b/c they will interfere with the electrocardiographic recorder device.

hear failure

inability of hert to maintain adequate cardiac output to meet the matabolic needs o the body b/c of impaired pumping ability. Diminished cardiac output results in inadequate peripheral tissue perfussion. Congestion of the lungs and periphery may occur. The client can develop acute pulmonary edema. Acute heart failure occurs suddenly. Chronic heart failure dvelops over time ; however, a client with chronic heart failure can develop and acute episode.

vagal maneuvers

induce vagal stimulation of the cardiac conduction system and are used to terminate supraventricular tachydysrhythmias.

pacemakers; client education

instruct client about the pacemaker, including progammed rate. Instruct on signs of battery failure and when to notify hcp. client to: report fever, redness, swelling, drainage from insertion site, dizziness, weakness, fatigue, swelling of ankles or legs, chest pain, SOB. Keep a pacemaker identification card in walled, obtain Medic-Alert bracelet. Instruct client on how to take the pulse, take the pulse daily, and to maintian a diary of pulse rates, wear loose-fitting clothing over the pulse generator site. avoid contact sports; inform hcp that pacemaker is inserted; inform airport security b/c pacemaker can set off security detector. Instruct that most electrical appliances can be used without anyi interference with the functioning of the pacemaker; however, advise client not to operate electrical appliances directlyh over pacemaker site. Avoid transmitter towers and antitheft devices in stores. Instruct client that if any unusual feelings occur when near any electrical devices to move 5 to 10 feet away and chck pulse. Instruct client about the methods of monitoring the function of the device. Emphasize the importance of follow-up with the HCP. Use cell phones on the side opposite to the pacemaker.

instructions for the client with deep vein thrombophlebitis

instruct client concerning the hazards of anticoagulation therapy. Recognize the signs and symptoms of bleeding. Avoid prolonged sitting or standing, constrictive clothing, or crossing legs when seated. Elevate the legs for 10 to 20 minutes every few hrs each day. Plan a progressive walking program. Inspect the legs for edema, and measure the circumference of the legs. Wear antiembolism stockins if they are prescribed. Avoid smoking. Avoid any meds unless prescribed by the hcp. Instruct the client concerning the importance of follw-up hcp visits and lab studies. Obtain and wear a Medi-alert bracelet.

Buerger's disease data collection

intermittent claudication, ischemic pain occurring in the digits while at rest, aching pain that is more severe at night, cool, numb, tingling sensation, diminished pulses in the distal extremities, extremities that are cool and red in the dependent position, development of ulcerations in the extremities

defibrilaltion

is an synchronous countershock used to terminate pulsesless VT of VF. The defibrillator is charged to 120 to 200 joules (biphasic) or 360 joules (monophasic ) fro one countershock form the defibrillator, and then CPR is immediately resumed and continued for 5 cycles is immediately resumed and continued for 5 cycles or about 2 minutes. The rhthm is rechecked after 2 minutes, and if VF or pulseless VT continues, the defibrillator is charge dto give a second shock, and the life support protocol is continued. Before defibrillating a client, be sure that the oxygen is shut off to avoid the hazard of fire and be sure tha no one is touching the bed or the client.

myoglobin...........

level rises within 2hrs after cell death, with a rapid decline in the level after 7hrs.

troponin level

level rises within 3 hrs level remains elevated for up to 7 to 10 days.

total cretine kinase level

level rises within 6 hrs after the onset of chest pain. level peaks within 18 hrs after damage and eath of cardiac tissue

atrioventricular (AV) node

located in the lower aspect of the atrial septum. Receives electrical impulses from the SA node. IF the SA node fails, the AV nose can initiate and sustain a hear rate of 40-60 beats/min

hypertensive crisis interventions

maintain a patent airway. IV antihypertensive meds may be prescribed. Monitor vitals, checking BP every 5 minutes. Monitor for hypotension during the administration of antihypertensives. Place the client in a supine position if hyotension occurs. Have emergency meds and resuscitation equipment readily available. Maintain bed rest, with teh head of the bed elevated at 45 degrees. Moitor IV therapy, monitoring for fluid overload. Monitor I & O. Insert a Foley catheterh as prescribed. Monitor urinary output, and if oliguria or anuria occurs, notify the HCP

interventions following acute episode MI

maintain bed rest for first 24-36hrs as prescribed. Allow client to stand to void or use a bedside commode if prescribed. Provide range-of-motion exercises to prevent thrombus formation and maintain muscle strength. Progress tod angling legs at the side of the bed or out of bed to the chair for 30 minutes three times a day as prescribed. Progress to dangling legs at the side of the bed or out of bed to the chair for 30 minutes three times a day as prescribed. Progress toa mbulation in the client's room and to the bathroom and then in the hallway three times a day. Monitor for complications. Encourage the client to verbalize feelings regarding the MI.

secndary htn data collectioin

may be asymptomatic, headache, visual distrubances, dizziness, chest pain, tinnitus, flushed face, epistaxis

Transmyocardial resvascularization

may be used for clients with widespread atherosclerosis involving vessels that are too smalland numerous for replacement of balloon catheterization. The procedure is performed thru a small chest incision. Trasmyocardial revascularization uses a highpowered laser that creates 20-24 channels thru the ventricular muscle of the left ventricle, and blood enters these small channels, providing the affected region of the heart with oxygenated blood. The opening on the surface of the heart heals; however, the main channels remain and perfuse the myocardium.

valve replacement procedures

mechanical prosthetic valves: these prosthetic valves are durable Thomboembolism is a problem after valve replacement with a mechanical prostehtic valve, and lifetime anticaogualant therapy is required

pharmacological interventions

med therapyi is individualized for each client, and the selection of the med is based on such factors as client's age, culture, presence of coexisting conditions, severityof htn, and client's preferences.

restrictive cardiomyopathy

mimics constrictive pericarditis fibrosed walls cannot expand or contract chamber snarrowed; emboli common

aortic aneurysms nonsurgical interventions

modify the risk factors. Reinforce instructions to the client regarding the procedure for monitoring BP. Reinforce instructions to the client on theimportance of regular HCP visits to follow the size of the aneurysm. Reinforce instructions to the client to notify the HCP immediately if any of the following occur: severe back or abdominal painor fullness, soreness over the umbilicus, sudden development of discoloration in the extremiteis, ora persistent elevation of BP. INstruct the client with an aortic aneurysm to report immediately the occurrence of chest or back pain, SOB, difficulty swallowing, or hoarseness.

Peripheral arterial revascularization preoperative interventions

monitor baseline vitals and peripheral pulses. Insert an IV line and urinary catheter as prescribed. Maintain a central venous catheter and/or arterialline if iserted

embolectomy postoper interventions

monitor cardiac, respiratory, neurological status. Mointor affected extremity for color , temp, pulse monitor sensory and motor function of the affected extremity. Monitor for sensory and motor function of the affected extremity. Monitor for signs and symptoms of new thrombi or emboli. Administe roxygen as prescribed. Monitor pulse oximetry. Monitor for complications caused by reperfusion of the artery, succh as spasms and swelling of the skeletal muscles. Monitor for signs of swollen skeletal muscles such as edema, pain on passive movement, poor capillary refill, numbness, and muscle tenseness. Maintain bed rest initially, with the client in a semi-Fowler's position. Place a bed cradle on the bed. Check incision site for bleeding or hematoma. Administer anticoagulants as prescribed. Instruct the client to recognize the signs and symptoms of infection and edema. INstruct the client to avoid prolonged sittnig or crossing the legs when sitting. Reinforce instructions to the client to elevate the legs when sitting. Reinforce instructions to the client to elevate the legs when sitting. Reinforces instructions to the client to ambulate daily. Reinforce instructions to the client about anticoagulant therapy and the hazards associated with anticaogulants.

bioprosthetic valves postoperative interventions

monitor closely for signs of bleeding. Monitor cardiac output and for signs of heart failure. Administer digoxin (Lanoxine) as prescribed to maintain cardiac output and prevent atrial fibrillation

raynaud's disease interventions

monitor pulses, administer vasodilators as prescribed, reinforce instructioins to the client regarding med therapy, assist the client to identify and avoid precipitating factors such as cold and stress. Reinforce instructions to the client to avoid smoking. Reinforce instructoins to the client to wear warm clothing, socks, and gloves in cold weather. Advise the client to avoid injureis to fingers and hands.

thoracic aneurysm postoperative interventions

monitor vitals and neurological and renal status Monitor for signs of hemorrhage, such as a drop in BP and increased pulse rate and respiration, and report to the HCP immediately. Monitor chest tubes for an increase in chest drainage, which may indicate bleeding or separation at the graft site. Mointor sensation and motion of all extremiteis and notify the HCP if deficits occur, which can be caused by a lack of blood supply to the spinal cord during surgery. Monitor respiratory status and auscultate breath sounds to identify respiratory complications. Encourage turning, coughing, and deep breathing while splinting the incision. Monitor cardiac status for dysrhythmias. Monitor for pain and administer med as prescribed. Monitor the incision stie for bleeding or signs of infection. Prepare the client for discharge by providing instructions regarding pain management, wound care, and activity restrictions. Reinforce instructions to the client anot to lift objects heavier than 15 to 20lb for 6 to 12 weeks. Advise the client to avoid activiteis requireing pushing, pulling, or straining. Reinforce instructions to the client not to drive a vehicle until approved by the HCP.

transfer from the cardiac surgical unit

monitor vitals, LOC, and peripheral perfusion (Alarm safety and alarm fatigue). Monitor for dyisrhythmias. Auscultate lungs and monitor respiratory status. Encourage the client to splint the incision, cough and dep breathe, and sue the incentive spirometer to raise secretions and prevent atelectasis. Monitor temp and white blood cellcount, which indicate infection if elevated after 3 to 4 days. Provide adequate fluids and hydration as prescribed to liquefy secretions. Monitor suture line and chest tube insertion sites for redness, purulent discharge,and signs of infection. Monitor sternal suture line for instability, which may indicate an infection. Guide the client to gradually resume activity. Monitor the client for tachycardia, postural (orthostatic) hypotension, and fatigue before, during, and after activity. Discontinue activities if the BP drops more than 10 to 20 mm Hg or the pulse increases more than 10 beats/min. Monitor episodes of pain closely.

diagnostic tests interventios

monitor vitals, check risk factors for the arterial disease process. Obtain info regarding back or abdominal paion, question the client regarding the sensation of pulsation in the abdomen. INspect the skin for the presence of vascular disease or breakdown. Check peripheral circulatioin, including pulses, temp, and color. Observe for signs of rupture. Note any tenderness over the abdomen. Monitor for abdominal distention

aortic aneuriysms postop interventions

monitor vitals, monitor peripheral pulses distal to the graft site, monitor for signs of graft occlusion, including changes in pulses, cool to cold extremiteis below the graft, white or blue extremiteies or flanks, severe pain, or abdominal distention. Limit elevation of the head of the bed to 45 degrees to prevent flexion of the graft. Monitor for hypovolemia and kidney failure resulting from significant blood loss during surgery. Monitor urine output hourly, and notify the HCP if it is less than 30-50 mL/hour. Monitor serum creatinine and blood urea nitrogen daily. Monitor respiratory status and auscultate breath sounds to identify respiratory complications. Encourage turning, coughing, and deep breathing, as well as splinting of the incision. Ambulate as prescribed. Maintain nasogastric tube to low suction untril bowel sounds return. Monitor bowel sounds and report their return to the HCP. Monitor for pain and administer med as prescribed. Monitor incision site for bleeding or signs of infection. Prepare the client for discharge by providing instructions regarding pain management, wound care, and activity restrictions. Reinforce instructions to the client not to lift objects heavier than 15 to 20lb for 6 to 12 weeks. Advise the client to avoid activities requiring pushing, pulling, or straining. Reinforce instructions to the client not to drive a vehicle until approved by the hcp.

Peripheral arterial revascularization postoperative interventions

monitor vitals; monitor the BP and notify hcp if changes occur. monitor for hypotensioin, which may indicate hypovolemia. monitor for htn, which may place stress on the graft and facilitate clot formation. Maintain bedrest for 24 hrs as prescribed. Instruct to keep affected extremitity straight, limit movement, avoid bending knee and hip. MOintor for warmth, rendess, a edema, which are often expected outcomes b/c of increased blood flow. monitor graft occlusion, which oftenoccurs within frist 24hrws. monitor periopheral pulses and for adverse change sin color and temp of the extremity. Encourage coughing and deep breathing and the use of incentive spirometry. Maintain NPO status, with progressive to clear liquids as prescribed. Use strict aseptic technique when in contact with the incision. monitor the incision for drainage, warmth , or swelling . Monitor for excessive bleeding. (A small amount of bloody drainage is expected) Monitor area over teh graft for hardness, tenderness, and warmth, which may indicate infection. If this occurs, notify the hcp immediately. Reinforce instructions to the client about proper foot care and measures to prevent ulcer formation. Reinforce instructions to the client to take meds as prescribed. Reinforce instructions to the client on how to care for the incision. Assit the client in modifying lifestyle (such as diet) to prevent further plaque formation. After arterial vascularization, monitor for a sharp increase in pain b/c pain is frequently the first indicator of postoperative graft occlusion. If signs of graft occlusion occur, notify hcp immediately.

diagnostic studies interventions

monitoring pain; instituting pain relief measures. Administering oxygen by nasal cannula as prescribed. Checking vitals and providing continuous cardiac monitoring and nitroglycerin as prescribed to dilate the coronary arteries, reduce the oxygen requirements of the myocardium, and relieve the chest pain. Ensuring bed rest is maintained, placing the client in semi-Fowler's position, and staying with the client. obtaining a 12 lead ECG. Establishing an IV access route

deep vein thrombophlebitis

more serious than a superficial thrombophlebitis b/c of the risk for pulmonary embolism.

atrial fibrillation

multiple rapid impulses from many foci depolarize in the atria in a totally disorganized manner at a rate of 350 to 600 times per minute; the atrai quiver; which can lead to the formation of thrombi. Usually no definitive P wave can be observed-only fibrillatory waves before each QRS. Tretment includes oygen, anticoagulants, cardiac meds, and possible cardioversion. Notify RN

Hypermagnesimia

muscle weakness, hypotension, bradycarida Electrocardiographic changes may be observed with hypermagnesemia include a prolonged PR interval and widened QRS complex. Electrolyte and mineral imbalances can cause cardiac electrical instability that can result in leife-threatening dysrhythmias

myocardial infarction...

myocardial infarction occurs when myocardial tissue is abruptly and severely depreived of oxygen. SIchemia can lead to necrosis of myocaridal tissue if blood flwo is not restored. Infarcation does not occur instantly but evolves over several hours. Obvious physical changes do not occur in the heart until six hrs afte rthe infarction, when the infarcted area sppears blue and swollen . After 48 hrs, the infarct turns gray with yellow streaks developing as neutrophils invade the tissue. By 8-10 days after infarction, granulation tissue forms. Over 2-3 months, the necrotic area develops into a scar. Scar tissue permanently changes the size and shape of the entrie left ventricle. Not all clients experience the classic symptoms of an MI. Women may experience atypical discomfort, SOB, or fatigue and often present with NSTEMI (non-ST-elevation myocardial infarction) or T-wave inversion An older client may experiecne SOB, pulmonary edma, dizziness, altered mental status, or dysrthymia.

meds

nitrates to dilate the coronary artereis and decrease preload and afterload. calcium channel blocker sto dilate coronary arteries and reduce vasospasm. Cholesterol-lowering meds to reduce the development of atherosclerotic plaques B-blockers to reduce the BP in individuals who are hypertensive

primary or essential htn

no known cause risk factors: aging, fam history, obesity, African American race, smoking, stress, excessive alcohol, hyperlipidemia, increased intake of salt or caffeine

temporary pacemakers

noninvasive transcutaneous pacing: Noninvasive transcutaneous pacing is used as a temporary emergency measure in the profoundly bradycardic or asystolic client until invasive pacing can be initiated. Large electrode pads are placed on the client's chest and back and connected to an external pulse generator. Wash the skin with soap and wate rbefore applying electrodes. If it not necessary to shave the hair of apply alcohol or tinctutes to the skin. Place the posterior electrode btwn the spine and left scapula, behind the heart, avoiding placement over bone. Place the anterior electrode btwn the V2 and V5 positions over the heart. Do not place the anterior electrode over female breast tissue; rather , displace breast tissue and place under the breast. Do not take the pulse or BP on the left side. The results will not be accurate b/c of the muscle twitching and electrical current. Ensure that electrodes are in good contact with the skin. If loss of "capture" occurs, check the skin contact of the electrodes and increase the current until "capture" is regained. Evaluate the client for discomfort from cutaneous and muscle stimulation. Adminster analgesics as needed.

cardiac dysrhythmias

normal sinus rhythm rhythm originates from the sioatrial node. atrial and ventricular rhythms are regualr at 60-100 beat/min

myocardial nuclear perfusion imaging (MNPI)

nuclear cardiology is the use of radionuclide techniques and scanning in cardiovascular assessment. The most common tests include technetium pyrophosphate scanning, thallium imaging, and multigated cardiac blood pool imaging; can evalaute cardiac motion and calculate the ejection fraction preprocedure interventions: obtain informed consent. Inform the client that a smalla mount of radioisotope will be injfected and that the radiation exposure and risks are minimal. postprocedure interventions: monitor vitals. Monitor injection site for bleeding or discomfort. Inform the client that fatigue is possible.

location of MI

obstruction of the left anterior descending artery results in anterior or septal MI or both. BOstruction of the circumflex artery results in posterior wall MI or lateral wall MI. Obstruction of the right coronary artery results in inferior wall MI. risk factors: atherosclerosis, coronary artery disease, elevated cholesterol levels, smoking, htn, obesity, phsycial inactivity impaired glucose tolerance, stress

embolectomy preop interventions

obtain a baseline vascular assessment. Administer anticoagulants as prescribed. Adminsiter thrombolytics as prescribed. Place a bed cradle on the bed. Avoid bumping or jarring the bed. Maintain the extremity in slightly dependent position.

interventions acute stage MI

obtain a description of chest discomfort. Administer oxygen by nasal cannula as prescribed and institue pain relief measures (morphine, nitroglycerin as prescribed) Monitor vitals and cardiovascular status and maintain cardiac monitoring. Ensure bed rest and place the client in a semi-Fowler's position to enhance comfort and tissue oxygenation; stay with the client. Assit to establish an IV access route. Obtain a 12-lead ECG. Assit to administer antidysrhythmics as prescribed. Assist to administer thrombolytic therapy which may be prescribed within the first 6hrs of the coronary event. Monitor for signs of bleeding if the client is receiving thombolytic therapy. Monitor lab values as prescribed. Administer B-blockers as prescribed to slow the heart rate and increase myocardial perfusion while reducing the force of myocardial contraction. Monitor for complications related to the MI. Monitor for cardiac dysrhythmias b/c tachycardia and PVCs frequently occur in the first few hours after MI. Monitor distal peripheral pulses and skin temp b/c poor cardiac output may be identified by cool diaphoretic skin and diminished or absent pulses. Monitor I & O. Monitor respiratory rate and breath sounds for signs of heart failure, as indicated by the presence of crackles or wheezes or dependent edema. Monitor Bp closely after the administration of meds. If the systolic BP is lower than 100 to 25 mm Hg lower than previous reading, lower the head of the bed and notify the HCP. Provide reassurance to the client and family.

cardioversion preprocedure interventions

obtain an informed consent if it is an elective procedure. Adminsiter sedation as prescribed. IF it si an elective procedure, hold digoxin (lanoxin) 48 hrs preprocedure as prescribed to prevent postcardioversion ventricular irritability. If it is an elective procedure for atrail fibrillation or atrial flutter, the client should received anticoagulant therapy for 4 to 6 wks preprocedure and a tranesophageal echocardiogram (TEE) should be performed to rule out clots in the atria prior to the procedure.

preprocedure interventions

obtain an informed consent if required. Provide adequate rest the night before the procedure. Reinforce instructions to the client about oral intake as prescribed (to maintain an NPO status or eat a light meal 1 to 2 hours before the procedure) Reinforce instructions to the client to ask the hcp about taking prescribed medication on the dayof procedure. Theophylline products are usually help 12 hrs before the test, and calcium channel blockers and B-blockers are ususally withheld on the day of the test to allow the heart rate to increase during the stress portion of the test. Reinforce instructions to the client to wear nonconstrictive, comfortable clothing and supportive rubber-soled shoes for the exercise stress test. Reinforce instructions to the client to notify the HCP if any chest pain, dizziness, or SOB occurs during the procedure postprocedure interventions: instruct client to avoid taking a hot bath or shower for at least 1-2 hrs

Valvular Heart Disease

occurs when the heart valves cannot fully open (stenosis) or close completely (insufficiency or regurgitation) valvular heart disease prevent efficient blood flow thru the heart

myocardial infarction

occurs without cause, primarily ealry in the morning Crushing substernal pain may radiate to the jaw, back, and left arm Lasts 30 minutes or longer Is unrelieved by rest or nitroglycerin, and relieved only by opioids

htn

organ involvement: eyes, brain, cardiovascular system, kidneys complications: visual changes, stroke, heart failure, hypertensive crisis, kidney failure

invasive transvenous pacing

pacing lead wire is placed thru the antecubital, femoral, jugular, or subclavian vein into the right atrium or right ventricle so that it is in direct contact with the endocardium. Moitro cardiac rhythm continnuously. Monitor vitals. Monitor the pacemaker insertion site. Restrict client movement to prevent lead wire displacement.

thoracic aneurysm data collection

pain extending to neck, shoulders, lower back, or abdomen syncope, syspnea, increased pulse, cyanosis, weakness, hoarseness/difficulty swallowing b/c of pressure from the aneurysm

varicose veins data collection

pain in the legs with dull aching after standing. A feeling of fullness in the legs. Ankle edema

MI data collection?

pain, nausea, vomiting, diaphoresis, dyispnea, dysrhythmias, feeling of fear and anxiety, pallor, cyanosis, coolness of extremities pain relief increases oxygen supply to the miocardium. Morphine sulfate is administered as a priority in managing pain in the client having an MI

CK-MB isoenzyme

peak elevation occurs 18 hrs after the onset of chest pain. level returns to normal 48 to 72 hrs later

Peripheral arterial revascularization

performed to increase arterial blood flow to the affected lim. INflow procedure sinvolve bypassing the arterial occlusion above the superficial femoral arteries. Outflow procedrues invovle bypassing the arterial occlusions at or below the superficial femoral arteries. Graft material is sutured above and below the occlusion to facilitate blood flow around the occlusion

Actions to take if a client develops pulmonary edema

place client in a high Fowler's position. Administer oxygen. Check client quickly, including checking lung sounds. Ensure an intravenous access device is in place. PRepare for the administration of a diuretic and morphine sulfate. Insert a Foley catheter as prescribed. Prepare for intubation and ventilator support, if required. Document the event, actions taken, and the client's response pulmonary edema is a life threatening event that can result from severe heart failure. IN pulmonary edema, the left ventricle fails to eject sufficient blood, and pressure increases in the lungs b/c of the accumulated blood. The nurse asssits the RN in implementing emergeny measures. The client is immediately placed in a high Fowler's position, with the legs in adependent position, to reduce pulmonary congestion and relieve edema. Oxygen is always prescribed, usually in high concentrations by mask or cannula to imporve gas exchange and pulmonary function; the goal is to keep the oxygen saturation above 90%. The client is then checked quickly, including checking the lung sounds. NExt, it is important to ensure that an IV access device is in place for the administration of a diuretic and morphine sulphate. Furosemide, a rapid-acting diuretic, will eliminate accumulated fluid. Morphine sulfate reduces venous return (preload), decreases anxiety, and also reduces the work of breathing. A foley catheter is inserted to measure output accurately. The nurse then prepares for intubation and ventilator suppor, if required. The nurse stays with the client and provides reassurance. Vital signs are monitored and a cardiac monitor is used to monitor the heart rate and for dysrhythmias. The lung sounds are monitored for crackles, decreased breth sounds and for a response to treatemtn. A weight measurement will also determine a response to tretment. Other interventions may include the administration of digoxin to increase ventricular contractility and improve cardiac output; bronchodilators for severe bronchospasm or bronchoconstriction; meds to facilitate myocardial contractility and enhance stroke volume; and vasodilators to reduce afterload, increase the capacity of the systemic venous bed, and decrease venous return to the heart. The nurse finally documents the event, the actions taken, and the clients, response.

pericarditis data collction

precordial pain in the anterior chest that radiates to the left side of the neck, shoulder, or back, pain is grating and is aggravated by breathing (particularly inspiration), coughin, and swallowing. Pain is worse when in the supine position and may be reliev3ed by leaning forward. Pericardial friction rub (scratchy, high-pitched souind) heard on auscultation and producted by the rubbing of the inflamed pericardial layers. Fever and chills , fagigue, malaise, elavated WBC count, electrocradiogram changes with acute pericarditis; ST segment elevation with the onset of inflammation; atrial fibrillation is comon. Signs of right ventricular failur in clients with chronic constrictive pericarditis

cardioversion postprocedure intervention

priority data colelction includes the ability of the client to maintain airway and breathing. Resumeoxygen administration as prescribed. MOnitor vitals. monitor LOC; monitor cardiac rhythm; monitor for indications of successful response such as conversion to sinus rhythm, strong peripheral pulses, an adequate BP, an adequte urine output. CHeck the skin on the chest for evidence of burns from the edges of the paddles/pads

cardiac rehabilitation

process of actively assisting the client with cardiac disease to achieve and maintain a vital and productive life within the limitations of the heart disease

home care instructions after cariac surgery

progressively return to activities at home. limit pushing or pulling activities for six wks after discharge. Maintain incisional care, and record signs of redness, swelling, or drainage. Sternotomy incision heals in about 6 to 8 wks. Avoid crossinglegs. Wear elastic hose if prescribed until edema subsides, and elevate surgical limb when sitting in a chair. Follow prescribed dietary measures such as avoiding saturated fat, cholesterol, and salt. Sexual intercourse can be resumed on the advice of the HCP after exercise tolerance is assessed. IF prescribed, if the client can walk one block or climb two flights of stairs without symptoms, he or she can resume sexual activity safely.

abdominal aneurysm

prominent, pulsating mass in the abdomen, at or above the umbilicus Systolic bruit over the aorta, tenderness on deep palpation, abdominal or lower back pain

endocarditis interventions

provide adequate rest balanced with activity to prevent thrombus formation. Maintain antiembolism stockings. Monitro cardiovascular status. Monitor for signs of heart failure. Monitor for signs of emboli. Monitor for splenic emboi, as evidenced by sudden abdominalpain radiating to the left shoulder, and the presence of rebound abdominal tenderness on palpation. Monitor for renal emboli, as evidenced by flank pain radiating to the groin, hematuria, and pyuria. Mointor for confusion, aphasia, or dysphasia, which may indicate CNS emboli. Monitor for pulmonary emboli as evidenced by pleuritic chest pain, dyspnea, and cough. MOnitor skin, mucuous membranes, and conjunctiva for petechiae. Monitor nail beds for splinter ehmorrhages. Monitor for Osler's nodes on the pads of the fingers, hands, and toes. Monitor for Janeway lesions on the fingers, toes, nose, or earlobes. Moitor for clubbing of the fingers. Evaluate blood culture results.Admininster antibiotics intravenously as prescribed. Plan and arrange for discharge, providing resources required for the continued administration of antibiotics intravenously.

deep vein thrombophlevitis interventions

provide bed rest as prescribed Elevate the affected extremity above the level of the heart as prescribed. Avoid using the knee gatch of pillow under the knees. Do not massage the extrmity. Support stockings may be prescribed (although their use is controversial ) to reduce evnous stais and to assit in the venous return of blood to the heart. Adminster intermittent or continuous warm, moist compresses as prescribed. Palpate the site gently, monitoring for warmth and edema. Measure and record the circumferences of the thighs and calves. monitor for SOB and chest pain, which can indicate pulmonary emboli. Administer thrombolytic therapy (tissue plasminogen activator ) if prescribed, which must be initiated within 5 days after the onset of symptoms. Administer heparin therapy as prescribed to prevent enlargemnt of the existing clost and prevent the formation of new clots. Monitor activated partial thromboplastin time during heparin therapy. Administer warfarin (Coumadin) as prescribed following heparin therapy when the symptoms of deep vein thrombophlevitis have resolved. Monitor prothrombin time and international normalized ration during warfarin (coumadin) therapy. Monitor for the hazards and side effects associated with anticoagulant therapy. Adminster analgesics as prescribed to reduce pain. Adminster diuretics as prescribed to reduce lower extremity edema

venouis insufficiency wound care

provide care to the wound as prescribed by the HCP monitor the client's ability to care for the wound, and initiate home care resouces as necessary. If an Unna boot (adressing constructed of gauze moistened with zinc oxide) is prescribed, the HCP will change it weekly. The wound is cleansed with normal saline before application of the Unna boot. Povidone-iodine (Betadine) and hydrogen peroxide are not used b/c they destroy granulation tissue. The Unna boot is covered with an elastic wrap that hardens to promote venous return and prevent stasis. Monitor for signs of arerial occlusion from an Unna boot that may be too tight. Keep tape off the client's skin. Occlusive dressings such as polyethylene film or hydrocolloid dressings may be used to cover the ulcer

cardiac catheterization-

provides the most definitive source for diagnosis. cardiac catherization shows the presence of atherosclerotic lesions

chest xray film

radiography of the chest is done to determine the size, silhouette, and position of the heart. Specific pathological changes are difficult to determine via x-ray film, but anatomical changes can be seen intervention: prepare the client for x-ray film, explaining the purpose and procedure. Remove jewelry

electrocardiography--

readings are normal during rest, with ST depression and/or T wave inversion during an episode of pain

phlebitis-

red, warm area radiating up the vein of an extremity. Pain, soreness, swelling

establishing an IV access route

reinforce instructions to the client regarding the purpose of diagnostic medical and surgical procedures and the preprocedure and postprocedure expectations. Assit the client to identify angina-precipitating events. Reinforce instructions to the client to stop activity and rest if chest pain occrs and to take nitroglycerin as prescribed. Reinforce instructions to the client to seek medical attention if pain persists. Reinforce instructions to the client regarding prescribed meds. Provide diet instructions to the client, stressing that dietary changes are not temporary and must be maintained for life. Assist the client to identify risk factors that can be modified. Assit the client to set goals that will promote changes in lifestyle ro reduce the impact of risk factors. Assist the client to set goals that will promote changes in lifestyle to reduce the impact of risk factors. Assist the client to identify barriers to compliance with therapeutic plan an dto identify methods to overcome barriers. Provide community resources to the client regarding exercise, smoking reduction, and stress reduction.

embolectomiy

removal of an embolus from an artery usinga catheter. A patch graft mayi be required to close the artery.

venous insufficiency

results from prolonged venous htn which stretches the veins and damages the valves. The resultant edema and venous stasis cause venous stasis ulcers, swelling, and celulitis. Treatment focuses on decreasing edema and promoting venous return from the affected extremity. Treatment for venous stasis ulcers focuses on healing the ulcer and preventing stasis and ulcer recurrence.

obstructed cardiomyopathy signs and symptoms

same as for nonobstructed except with mitral regurgitation murmur atrial fibrillation

obstructed cardiomyopathy

same as nonobstructed, except for obstruction of left ventricular outflow tract associated with the hypertrophied septum and mitral valve incompetence

rupturin aneurysm

severe abdominal or back pain, lumbar pain radiating to the flank and groin, hypotension, increased pulse rate, signs of shock, hematoma at flank area

phosphorus

should be interpreted with calcium levels b/c the kidneys retain or excrete one electrolyte in an inverese relationship to the other

left sided heart failure

signs of pulmonary congestion; dyspnea, tachypnea, crackles in the lungs, dry hacking cough, paroxysmal nocturnal, dyspnea, increased BP (from fluid volume excess) or decreased bp (from pump failure)

pattern of angina

stable of angina: also called exertional angina. Occurs with activities that invovle exertion or emotional stress and is releived with rest or nitroglycerin. Usually has a strable pattern of onset, duration, severity, and relieving factors.

venous insufficiency data collection

stasis dermatitis or brown discoloration along the ankles and extending up to the calf Edema Ulcer formation: Edges are uneven, ulcer bed is pink, and granulation is present

autonomic nervous system

stimulation of sympathetic nerve fibes releases the neurotransmitter norepineprhine, producing an increased heart rate, increased conduction speed thru the AV node, increased atrial and ventricular contractility, and peripheral vasoconstriction. Stimulation occurs when a decrease in pressure is detected. Stimulation of the parasympathetic nerve fibers releases the neurotransmitter acetylcholine, which decreases the heart rate and lessens atrial and ventricular contractility and conductivity. Stimulation occurs when an increase in pressure is detected.

coronary arteries:

supply the capillaries of the myocardium with blood the right main coronary artery supplies the right atrium and ventricle, the inferior portion of the left ventricle, the posterior septal wall, and the sinoatrial and atrioventricular nodes. The left main coronary artery consists of two major branches, the left anterior descending and the circumflex arteries. the left anterior descending artery supplies blood to the anterior wall of the left ventricle, the anterior septum, and the apex of the let ventricle. The circumflex artery supplies blood to the left atrium and the lateral and posterior surfaces of the left ventricle. The coronary arteries supply the capillaries of the myocardium with blood. If blockage occurs in these arteries, the client is at risk for myocardial infarction.

restrictive cardiomyopathy treatment

supportive treatment of symptoms treatment of htn conversion from dysrhythmias exercise restrictions emergency treatment of acute pulmonary edema

abdominal aortic aneurysm resection

surgical resecction or excision of the aneursym. The excised section is replaced with a graft that is sewn end to end.

dilated cardiomyopathy treatment

symptomatic treatment of heart failure vasodilatros control of dysrhythmias surgery: heart transplant

nonobstructed cardiomyopathy treatment

symptomatic tretment b-Blockers Conversion of atrial fibrillation Surgery: ventriculomyotomy or muscle resection with mitral valve replacement Digoxin, nitrates, and other vasodilatros contraindicated with the obstructed form

systolic failure/diastolic failure

systolic failure leads to problems with contraction and the ejection of blood. Diastolic failure leads to problems with the heart relaxing and filling with blood

home care instructions for the client with endocarditis

teach to maintain aseptic technique during setup and administration of IV antibiotics. Instruct to administer IV antibiotics at scheduled times to maintain blood level. Instruct to monitor IV catheter sites for signs of infection and report immediately to the HCP. instruct to record his temp daily for up to six weeks and report fever. Encourage oral hygiene at least twice a day with a soft toothbrush and rinse well with water after brushing . CLient should avoid use of oral irrigation devices and flossing to avoid bacteremia. Teach to thoroughly cleanse any skin lacerations thoroughly and apply an antibiotic ointment as prescribed. Client should inform all HCPs of a history of endocarditis and rquest prophylactic antibiotics prior to every invasive procedure, including dental procedures. Teach client to observe for signs and symptoms of embolic pnenomena and heart failure

blood urea nitrogen

the blood urea nitrogen is elevated in heart disorders that adversely affect renal circulation, such as heart failure and cardiogenic shock

heart rate

the faster the heart rate, the less time the heart has for filling, and the cardiac output decreases. An increase in hear rate increases oxygen consumption. The normal sinus hear rate is 60-100 beats/min Sinus tachycardia is a rate greater than 100 beats/min. Sinus bradycardia is a rate less than 60 beats/min

heart sounds

the first heard souind (S1) is heard as the AV valves close and is heard loudest at the apex of the heart. The second heart souind (S2) is heard when the semilunar valves close and is heard loudest at the base of the heart. A third heart sound (S3) may be heard if ventricular wall compliance is decreased and structures in the ventricular wall vibrate; this can occur in conditions such as heart failure or valvular regurgitation. However, a third heart sound may be normal in individuals younger than 30 yrs. A fourth heart sound (S4) may be heard on atrial systole if resistance to ventricular filling is present; this is an abnormal finding, and the causes include cardiac hypertrophy, disease, or injury to the ventricular wall.

Valsalva's maneuver

the hcp instructs the client to bear down or induces a gag reflex in the client to stimulate a vagal response. Monitor the heart rate, rhythm, and BP. Observe the cardiac monitor for a change in rhythm. Record an electrocardiographic rhythm strip before, during, and after the procedure. Provide an emesis basin if the gag reflex is stimualted, and initiate precautions to prevent aspiration. Have a defibrillator and resuscitative equipment available.

carotid sinus massage

the hcp instructs the client to turn the head away from the side to be massaged the hcp massages over one carotid artery for a few seconds to determine if a change in cardiac rhythm occus. The client should be on a cardiac monitor, and an electrocardiogram rhythm strip before, during, and after the procedure should be obtained and documented on the chart. Have a defribilator and resuscitative equipment available. Monitor vitals, cardiac rhythm, and LOC afte the procedure

heart and heart wall layers

the heart is located in the left side of the mediastinum. heart has 3 layers: the epicardium is the outermost layer of the heart. the myocardium is the middle layer and actual contracting muscle of the heart. The endocardium is the innermost layer and lines the inner chambers and heart valves.

sinoatrial (SA ) node

the main pacemaker that initiates each heartbeat. located at thejunction of teh superior vena cava and the right atrium. The SA node generates electrical impulses at 60-100 times per minute and is controlled by the sympathetic and parasympathetic nervous systems.

coronaryy artery bypass grafting

the occluded coronary arteries are bypassed with the client's own venous or arterial blood vessels. The spahenous vein, internal mammary artery, or other artereis may be used to bypass lesions in the coronary artereis . Coronary artery bypass grafting is performed when the client does not respond to medical management of coronary artery disese ow when vessesl ae severely occluded.

commissurotomy/valvotomy

the procedure is accomplished with cardiopulmonary bypass during open heart surgery. The valve is visualized, thrombi are removed from the atria, fused leaflets are incised, and calcium is debrided from the leaflets, thus widening the orifice

permanent pacemakers

the pulse generator is internal and surgically implanted in a subcutaneous pocket below the clavicle. The leads are passed transvenously via the cephalic or subclavian vein to the endocardium on the right side of the heart. Postoperatively, limitation of arm movement on the operative side is required to prevent lead wire dislodgement. Permanent pacemaker smay be single chambered, in which the lead wire is plaed in the chambe rto be paced, or dual chambered, with lead wires placed in both the right atrium and ventricle . A permanent pacemaker is programmed when inserted and can be reprogrammed if necessari by noninvasive transmission from an external programmer to the implanted generator. Pacemakers are powered by alithium battery that has an average life span of 10 yrs, are nuclear powered with a life psan of 20 yrs, are nuclear powered with a life span of 20yrs or longer, or are designe dto be recharged externally. Pacemaker function can be checked in the HCP's office or clinic by a apacemaker interrogator or programmer or from home using telephone transmitte devices. The client may be provided with a device that is placed over the pacemaker battery generator with an attachment ot the telephone. The heart rate then can be transmitted to the clinic.

complete blood count

the red blood cell count decreases in rehumatic heart disease and infective endocarditis and increases in conditions characterized by inadequate tissue oxygenation. The white blood cell count increases in infectious and inflammatory diseases of the heart and after MI b/c large numbers of white blood cells are needed to dispose of the necrotic tissue resulting from the infarction. An elevated hct can result from vascular volume depletion. Decreases in hct and hgb can indicate anemia

there are four heart chambers

the right atrium receives deoxygenated blood from the body via the superior and infereior vena cava. The right ventricle recieves blood from the right atrium and pumps it to the lungs via the pulmonary artery. The left arium recieves oxygenated blood from the lungs via four pulmonary veins. The left ventricle is the largest and most muscular chamber. It receives oxygenated blood from thelungs via the left atrium and pumps blood into the systemic circulation via the aorta.

sodium

the serum sodium level decreases with the use of diuretics. The serum sodium level decreases in heart failure, indicating water excess

four valves in the heart

there are four valves in the heart there are two atroventricular (AV) valves- the tricusppied and the mitral- that lie btwn the atria and ventricles. The tricuspied valve is located on the right side of the heart. The bicuspid (mitral) valve is located on teh left side of the heart. The AV valves close at the beginning of ventricular contraction and prevent blood from flowing back into the atria from the ventricles. These valves open when the ventricle relaxes. there are two semilunar valves: the pulmonic and the aortic: the pulmonic semilunar valve lies btwn the right ventricle and the pulmonary artery. the aortic semilunar valve lies btwn the left ventricle and the aorta. The semilunar valves prevent blood from flowing back into the ventricles during relaxation. Theyopen during ventricular contraction and close when the ventricles begin to relax.

electrocardiography

this common noninvasive diagnostic test records the electrical activity of the heart and is usefulin detecting cardiar dysrhthmias, detecting location and extent of myocardial infarction, cardiac hypertrophy, and for evaluation of the effectiveness of cardiac meds. interventions: Determine the client's ability to lie still. Advise the client to lie still, breathe normally, and refrain from talking during the test. Reassure the client that an electrical shock will not occur. Document any cardiac meds the client is taking.

magnetic resonance imaging

this is noninvasive diagnostic test that produces an image of the heart or great vessesl thru interaction of magnetic fields, radio waves, and atomatic nuclei. It provides info on chamber size and thickness, valve and ventricular functioin, and blood flow thru the great vessels and coronary arteries. preprocedure interventions: Evaluate the client for the presence of a pacemaker or other implanted items that present a contraindication to the test. Ensure that the client has removed all metallic objects such as watches , jewelry, clothing with metal fasteners, and metal hair fasteners. Inform the client that he or she may experience claustrophobia while in teh scanner.

echocardiography

this noninvasive procedure is based on the principles of ultrasound and evaluates tructural and functional changes in the heart. Heart chamber size is measured, ejection fraction is calculated, and flow gradient across the valves is determined. A transesophageal echocardiography may be done in which the echocardiogram is done thru the esophagus; this is an invasive exam and requires pre- and postoprocedure preparation, and care is similar to endoscopy procedures. interventions: Detemine the client's ability to lie still, and advise the client to lie still, breathe normally, and refrain from talking during the test.

exercise electrocardiography testing (stress test)

this noninvasive test studies the heart during activity and detects and evalautes coronary artery disease Treadmill testing is the most commonly used mose of stress testing Stress testing may be used with myocardial radionuclide testing (perfusion imaging), at which point the procedure becomes invasive b/c a radionuclide must be injected. If the client is unable to tolerate exercise, an IV infusion of dipyradamole (Persantine), dobutamine hydrocholride, or adenosine (Adenocard) is given to dilate the coronary arteries and simulate the effect of exercise. An informed consent is required if a radionuclide is to be injected.

digital subtraction angiography

this test combines x-ray techniques and a computerized subtraction technique with fluoroscopy for visualization of the cardiovascular system. a contrast medium (dey) is injected preprocedure interventions: check for allergies to seafood, iodine, or radiopaque dyes. If allergic , the client may be premedicated with antihistamines and steroids to prevent a reaction obtain informed consent Postprocedure interventions: monitor vitals; monitor injection site for bleeding or discomfort

mitral annuloplasty:

tightening and suturing the malfunctioning valve annulus to eliminate or greatly reduce regurgitation

secondary htn

treatment depends on the cause and the organs involved. Secondary htn occurs as a result of other disorders or conditions. Precipitating disorders or conditons: cardiovascular disorders, renal disorders, encodcrin system disorders, pregnancy, meds (such as estrogens, glucocorticoids, and mineralocorticoids)

reducing the risk of microshock

use only inspected and approved eqiupment. Insulate the exposed portion of wries with plastic or rubber material (fingers of rubber gloves) when wires are not attached to the pulse generator, and cover with nonconductive tape. Ground all electrical equipment using a three-pronged plug. Wear gloves when handling exposed wires. Keep dressings dry

serum lipids

used to assess the risk of developing coronary artery disease the lipid profile measures serum cholesterol, triglyceride, and lipoprotein levels. the lipid profile is used to assess the risk of developing coronary artery disease. The desirable range for serum cholesterol is lower than 200 mg/dL, with low-density lipoprotein cholesterol lower than 130 mg/Dl and high-density lipoprotein cholesterol at 30-70mg/dL LIpoprotein-a or Lp (a), a modified form of LDL, increases atherosclerotic plaques and increases clots; value should be less than 30 mg/dL

aortic insufficiency-

valve is incompetent , preventing complete valve closure during diastole.

mitral valve prolapse

valve leaflets protrude into the left atrium during systole

mitral stenosis

valvular tissue thickens and narrows the valve opening, preventing blood flow from the left atrium to left ventricle. MItral insufficiency/regurgitation: the valve is incompetent, preventing complete valve closure during systole.

aortic stenosis-

valvular tissue thickens and narrows the valve opening, preventing blood flow from the left ventricle into the aorta

vein stripping

varicose veins are removed if theya re larger than 4mm in diamter or are in clusters; other treaments are usually tried before vein stripping. Preoperatively assit the HCP with vein marking. Evaluate pulses a baseline for comparison postoperatively. Maintain elastic (Ace) bandages on the client's legs postoperatively. Monitor the groin and leg for bleeding thru the elastic bandages. Monitor the extremity for edema, warmth, color, and pulses. Check for paresthesias, which could include saphenous nerve damage. Elevate the legs above the level of the heart postoperatively. Encourage rang-of-motion exercises of the legs. Reinforce instructions to the client ot avoid leg dangling or chair sitting. Reinforce instructions to the client to elevate the legs when sitting.

phlebitis

vein inflammation associated with invasive procedures such as IV lines

vena calval filter and ligation of infereior vena cava

vena cava filter: insertion of an intracaval filter (umbrella) that partially occludes the inferior vena cava and traps emboli to prevent pulmonary emboli Ligation: Suturing of placing clips on the inferior vena cava to prevent pulmonary emboli; performed via abdominal laparotomy preoperative interventions: If the client has been taking an anticoagulant, consult with the HCP regarding discontinuation of the med to preent hemorrhage Postoperative interventions: Maintain a semi-Fowler's position. Avoid hip flexion. Refer to postoperative interventions for embolectomy

risk factors for thrombus formation

venous statis from varicose veins, heart failure, and immobility hypercoagulability disorders Injury to the venous wall from IV injections; administration of vessel irritants (chemotherapy, hypertonic solutions) following surgery, particularly orthopedic and abdominal surgery pregnancy, ulcerative colitis, use of oral contraceptives, certain malignancies, fractures or other injureis of the pelvis or lower extremiteis

nonpharmacological interventions secondry htn

weight reduction, if necessary, or maintenance of ideal weight. Dietary sodium restriction to 2g daily as prescribed. Moderate intake of alcohol and caffeine-containing products. Initiation of a regular exercise program. Avoidance of smoking. Relaxation techniques and biofeedback therapy. Elimination of unecessary meds that may contribute to the htn

electrocardiography-

when blood flow is reduced and ischemia occurs, ST segment depression, T wave inversion, or both are noted. Teh ST segment returns to normal when the blood flow returns. With infarction, cell injury results in ST segment elevation, followed by T wave inversion and an abnormal Q wave.

preinfarction angina

-Associated with acute coronary insufficiency -Lasts longer than 15 minutes -Symptom of worsening cardiac ischemia -Characterized by chest pain that occurs days to weeks before an MI data colelction: pain, dyspnea, pallor, sweating; palpitations; tachycardia; dizziness; syncope; htn; digestive disturbances

phlebitis... interventions

-apply warm moist soaks as prescribed to dilate vein and promote circulation (check temp of soak before applying) MOnitor for signs of complications such as tissue necrosis, infection, or pulmonary embolus