NUR 408 Exam 1
Discuss the nursing management of intra- arterial - blood pressure monitoring
A transducer is attached, and pressure is measured in millimeters of mercury. the nurse monitors the patient for complications, which include local obstruction with distal ischemia, external hemorrhage, massive ecchymosis, dissection, air embolism, blood loss, pain, arteriospasm, and infection.
Myoglobin as a marker for MI
is a oxygen transporting protein which is found in skeletal and cardiac muscle. An increase in this level is not specific in diagnosing a cardiac event but if the levels are negative, the physician can rule out an acute myocardial infarction. Levels begin to rise 1-3 hours after the incident and peak by hour 12.
CI measurement
is a cardiodynamic measure based on CO, which is the amount of blood pumped by each ventricle in liters per minute.
Non-modifiable risk factors for CAD:
Family history (first-degree relative with CAD at 55 years or younger for men and at 65 years or younger for women) increasing age (more than 45 years for men and more than 55 years for women) gender (men develop CAD at an earlier age than women) race (higher incidence of heart disease in African Americans than in Caucasians)
What is the rationale for assessing distal pulses immediately after the catheterization?
Check the distal pulses after catheterization due to clotting complications. If pulses are absent, this can indicate that there is an arterial occlusion.
position required to measure the PAP correctly
Fluoroscopy may be used during insertion to visualize the progress of the catheter through the right heart chambers to the pulmonary artery and special attention is made to ensure that the balloon, used to travel to the pulmonary artery, is deflated.
High LDL as a marker for MI
Higher chance of CAD- Level should be below 70mg/dl Factors that lower HDL(which is bad): smoking, diabetes, obesity, and physical inactivity-so fix these!
What are the indications for the various hemodynamic monitoring methods intra-arterial line and the pulmonary artery pressure monitoring system?
Intra- arterial BP monitoring is used to obtain direct and continuous BP measurements in critically ill patients who have severe hypotension or hypertension. Arterial catheters are also useful when arterial blood gas measurements and blood samples need to be obtained frequently.
What are other symptoms besides chest pain are seen in MI ?
Jaw pain, headache, toothache, headache, shortness of breath, diaphoresis or breaking out in a cold sweat, palpitations, unusual fatigue, sometimes for days (especially women), Nausea or vomiting, Indigestion, Anxiety, feeling of impending doom, or denial that anything is wrong, Cool, pale, and moist skin, Lightheadedness, dizziness, or restlessness, Tachycardia or tachypnea, Crackles in lungs (if MI has caused pulmonary congestion), Pulmonary edema, Increased jugular vein distention (seen if MI has caused heart failure), Any sudden,
How potassium aids in the diagnosis of cardiovascular disease:
K+ should be between 3.5 - 5. A low potassium can cause dysrhythmias, ventricular tachycardia, ventricular fibrillation, and digoxin toxicity. Potassium influences skeletal and cardiac muscle activity. Alterations can change myocardial irritability and rhythm. Severe hypokalemia can cause cardiac arrest. Hyperkalemia is less common but more dangerous than hypokalemia because cardiac arrest is more frequent. (254-256) Common causes include alcoholism and its associated malnutrition, chronic diarrhea. High potassium can cause asystole or a heart block.
High HDL as a marker for MI
Low chance of CAD- Level should be above 40mg/dl
What are the nursing responsibilities when caring for the patient with hemodynamic monitoring?
Make sure it is properly working, make sure that the stopcock of the transducer is positioned at the atrium level, makes the landmark known as the phlebostatic axis as a reference point in means of pressure readings, change the sterile gauze dressing every 2 days and transparent dressings every 7 days and whenever dressings become damp, loosened, or visibly soiled; do not use topical antibiotic ointment or creams on insertion site,
valve prostheses- mechanical
Mechanical valves are of the bileaflet, tilting disk, or ball-and-cage design. They are thought to be more durable than tissue prosthetic valves, so they are often used for younger patients. These valves are also used for patients with renal failure, hypercalcemia, endocarditis, or sepsis who require valve replacement. (Used because these fails do not deteriorate or become infected as easily as tissue valves). Some complications associated with these valves are thromboemboli and long-term use of required anticoagulants
How magnesium aids in the diagnosis of cardiovascular disease:
Mg+ should be between 1.3 - 2.3 The effects of magnesium deficit or excess are inverse to calcium. An excess of magnesium diminishes the excitability of muscle cells, and a deficit increases neuromuscular irritability and contractility. It acts on the cardiovascular system to produce vasodilation and decreased peripheral resistance. (262)
How sodium aids in the diagnosis of cardiovascular disease:
Na+ should be between 135-145. Sodium levels are mainly used to measure fluid excess or deficit. Too low or too high levels of sodium can result in water imbalances and indicate a cardiovascular problem. (251) Hypernatremia can be caused by a decrease in water excretion, which may be related to the enhanced release of both angiotensin and vasopressin and can be exaggerated by diuretic therapy.
Discuss nursing management of a patient with an intra-aortic balloon pump
Nursing management includes 1:1 care and the following: Evaluate the patient's response to therapy in relation to haemodynamic status, control of arrhythmias, systemic vascular perfusion and relief of cardiac symptoms To monitor the patient for the early signs of complications and intervene to prevent harm To ensure that the IABP is functioning by confirming that the machine is delivering the correct timing To ensure that the nurse is able to undertake appropriate troubleshooting of all alarm situations and safe operation Monitor VS, I and O's, arrhythmia's, radial and pedal pulses hourly, and observe and record the IABP waveform.
After the cardiac catheterization, why is it important to assess the patient's BUN and creatinine, and fluid volume status?
Patients who undergo cardiac catheterization and also have other comorbid conditions are at risk for contrast agent-induced nephropathy. This is from the agent that is used during the catheterization process and it causes acute renal failure which can sometimes be reversed but temporary dialysis may be necessary. Baseline serum creatinine increases by 25% or more within two days of the procedure.
How BUN aids in the diagnosis of cardiovascular disease:
The BUN gives an estimate of renal function test by measuring the amount of nitrogen in the blood that comes from the waste product urea. An elevated BUN can indicate a lowered perfusion from decreased CO or an intravascular fluid deficit from dehydration. A volume depleted person has an elevated BUN and can be a result of decreased renal perfusion and function. (245)
Dylan Radin is 55 years of age and is a male patient who is admitted to the emergency department via ambulance with acute onset of midsternal chest pain radiating down the left arm and radiating up the left side of the neck. The patient complains of shortness of breath and is cool, pale, and diaphoretic. The vital signs include: BP 160/90, HR 110, R 26, and T 99°F. The 12 lead ECG reveals an anterior wall ST-elevation myocardial infarction (STEMI). • What first actions should the nurse take after the patient has arrived in the emergency department?
The first actions a nurse would take would be to immediately receive supplemental oxygen, aspirin, nitroglycerin, and morphine. Morphine is the drug of choice to reduce pain and anxiety. It also reduces preload and afterload, decreasing the work of the heart. A beta blocker may also be used if dysrhythmias occur. The goals of medical management are to minimize myocardial damage, preserve myocardial function, and prevent complications
positioning required to measure the CVP correctly
The preferred site is the subclavian vein. Avoid the femoral vein. During the procedure the physician threads a single-lumen or multilumen catheter through the vein into the vena cava just above or within the right atrium. Position of the catheter is confirmed by a chest x-ray. Have the bed elevated up to 60 degrees.
How an ECG aids in the diagnosis of cardiovascular disease:
This is the standard procedure for determining if a patient has a dysrhythmia. It is a noninvasive procedure which uses leads to monitor electrical activity from the heart. Certain patterns in waves note certain rhythms. There are several different types, but the 12 lead is the most common. It can also be used to pick up on chamber enlargement, myocardial ischemia, and conduction abnormalities. A 15-lead is used for early diagnosis of right ventricular and left posterior infarction. And the 18-lead is useful for early detection of myocardial ischemia and injury.
valve prostheses- biologic
Tissue valves can be three different types: bioprostheses (come from pigs, cows or horses), homografts (come from cadavers), and autocrats (obtained from patient's own pulmonic valve and portion of pulmonary artery). These valves are less likely to generate thromboemboli, and long term anticoagulation use is not required. They are not as durable as mechanical valves though, and require replacement more frequently
Lipid Profile- Cholesterol, triglycerides, and lipoproteins as a marker for MI
are measured to evaluate a person's risk for developing CAD. HDL and LDL transport these two into the blood, the more HDL you have the lower chance of getting CAD. The higher LDL you have the higher chance of getting CAD. A blood specimen for lipid profile should be done AFTER a 12 hr fast.
The patient asks why he needs to stay in bed with the leg extended for 2 - 6 hours after a cardiac catheterization. How should the nurse respond?
because of the unstable angina, they had to insert the cardiac catheterization via the right femoral artery. Assess for bleeding complications at the site of catheterization as well as occlusions and hematoma formations. Keep leg straight and bed elevated no greater than 30 degrees.
Unstable angina
characterized by attacks that increase in frequency and severity and is not relieved with rest and/or the administration of nitroglycerin. It is also referred to as pre-infarction angina
What other assessments should the nurse perform to check for arterial insufficiency?
compare the unaffected side with the affected side- checking color, temperature, and capillary refill. It is also important to ask the patient if they are experiencing any pain, numbness, and tingling in that extremity. Check the patient's vital signs every 15 min for one hour, every 30 min for an hour, then hourly for 4 hours, or until discharge
Troponin as a marker for MI
is a protein found in myocardial cell. The isomer is specific for cardiac muscle and markers for myocardial injury. An increase in levels can be detected a few hours after injury or trauma. These levels remain elevated for long periods of time once activated.
CK-MB asa marker for MI
is an enzyme specific to heart muscle that will increase in levels when there has been damage to the cardiac tissue. If these levels are elevated it suggests that the patient has had an acute myocardial infarction. The levels start to elevate a few hours after trauma or ischemia and have peaked by 24 hours
MAP
is the average pressure at which blood moves through the vasculature.
The Pulmonary artery pressure monitoring including the PAS and the PAD:
is used for assessing left ventricular function and for evaluating the person's response to medical interventions. Monitoring of the PAD and the PAWP is particularly important in critically ill patients like this one in this case study because they are used to evaluate left ventricular filling pressures.
CVP
is used to measure right atrial pressure.
How coagulation studies aid in the diagnosis of cardiovascular disease:
measure your blood's ability to clot, as well as how long it takes. o These are important to access the safety of preforming invasive procedures on a patient to determine clotting time, or whether or not a patient is a candidate for certain medications such as Coumadin. If the blood is too thick, a clot can form in your lungs, heart, or brain, causing a heart attack or stroke. There are several different types of tests: Partial Thromboplastin Time (PTT): therapeutic range - 1.5-2.5 times baseline values. Measures the intrinsic pathway activity. Used to assess effects of heparin. Prothrombin Time (PT): Measures extrinsic pathway activity. Used to monitor level of anticoagulation with warfarin. International normalized ratio (INR): monitors effectiveness of warfarin. Therapeutic range - 2-3.5.
CK- Creatine Kinase as a marker for MI
more broad category which leads us to CK-MB
triglycerides as a marker for MI
normal range is 100-200mg/d these levels have a direct correlation with LDL so as these get high so does LDL and when these get high HDL goes down. Diabetes, alcohol, and obesity raise this level so we must treat these things to keep it lower.
The emergency physician has contacted a cardiologist and the patient is scheduled for a percutaneous coronary intervention (PCI) in less than 60 minutes from the door-to-balloon time. Explain the reasoning for this action based upon evidence- based guidelines and considering the clinical manifestations and the pathophysiology of the STEMI.
o An immediate PCI is ordered to open the occluded coronary artery and permute reperfusion to the area that has been deprived of oxygen. The procedure treats the underlying atherosclerotic lesion. Because the duration of oxygen deprivation determines the number of myocardial cells that die, the time for the patients arrival in the ED to the time the PCI is performed should be less than 60 minutes. This is frequently referred to as door-to-balloon time. o Early PCI has been shown to be effective in patients of all ages, including those older than 75 years. o When a patient is going through STEMI manifestations include: Patient has ECG evidence of acute MI with characteristic changes in two contiguous leads on a 12-lead ECG. In this type of MI, there is significant damage to the myocardium. Chest pain that occurs suddenly and continues despite rest and medication. Shortness of breath Indigestion Nausea Anxiety Cool, pale, and moist skin Heart rate and respiratory rate may be faster than normal
Identify procedural situations when antibiotic prophylaxis is indicated to prevent bacterial endocarditis
o Dental procedure involving manipulation of gingival tissue or periapical area of teeth or perforation of oral mucosa o Surgical procedures involving respiratory mucosa o Tonsillectomy or adenoidectomy o Urinary tract manipulation in patients infected with an UTI o Any surgery that may involve infected skin or musculoskeletal tissue o Bronchoscopy with incision of respiratory mucosa
Discuss nursing management of a CVP and PAP catheter
o Dress the site with sterile gauze or sterile, transparent,, semipermeable dressing to cover the catheter site. o Change gauze dressings every 2 days or transparent dressing at least every 7 days and whenever dressings become damp, loosened, or visibly soiled. o Do not use topical antibiotic ointment or creams on insertion site. o Asses the site regularly- visually when changing or by palpating intact dressing. Remove the dressing for a through assessment if the patient has tenderness at the site, fever without obvious source, or other signs of bloodstream infection. o Keep all components of the pressure monitoring system sterile. o Replace transducers, tubing, continuous device, and flush solution at 96 hour intervals. o Do not infuse dextrose containing solutions through the monitoring system. o Do not submerge the catheter or catheter site in water. o Showering is permitted if the catheter and related tubing are place in an impermeable cover. o Ask patients to report any new discomforts from the catheter site.
HDL (high-density lipoprotein) as it relates to CAD:
o HDL (high-density lipoprotein) is known as the "good" cholesterol. It gets this name because it transports other lipoproteins such as LDL to the liver where they can be degraded and excreted. Because of this, a high HDL level is a strong negative risk factor for heart disease. AKA: it protects against heart disease. The levels to help prevent CAD for men would be an HDL greater than 40 for males and greater than 50 for females.
Modifiable risk factors for CAD:
o Hyperlipidema o Cigarette smoking or tobacco use o Hypertension o Diabetes o Obesity o Physical inactivity
How an echocardiogram aids in the diagnosis of cardiovascular disease:
o Is more involved than an EKG but is noninvasive. There is no need for preparation and food can be eaten before the test. It uses ultrasound to image heart muscle and structures in and around the heart. It screens for structural abnormalities in the heart and is especially useful for diagnosing pericardial effusions, determining size of chambers and etiology of heart murmurs, evaluating valve function and ventricular wall motion. May be performed with a stress test. Findings of abnormalities in ventricular wall motion are highly suggestive of CAD. The device picks up echoes of the sound waves as they bounce off the different parts of your heart. There are types of Echocardiogram including Transthoracic echocardiogram (TTE), Stress echocardiogram, Doppler echocardiogram, and Transesophageal echocardiogram (TEE). It can detect wall movement and ejection fraction (743)
How cardiac stress testing aids in the diagnosis of cardiovascular disease:
o It is done by either exercise on a treadmill, pedaling a stationary exercise bicycle ergometer or with intravenous pharmacological stimulation using medicine such as adenosine or dobutamine, with the patient connected to an ECG. Stress test helps determine the following: presence of coronary artery disease, cause of chest pain, functional capacity of the heart after an MI or surgery, effectiveness of heart medications, occurrence of dysrhythmias, and goals for a fitness program. There are contraindications to a stress test, including: severe aortic stenosis, acute myocarditis or pericarditis, severe hypertension, suspected CAD, HF, and unstable angina. Complications of stress tests can be life-threatening. Stress test results may lead to further testing and procedures. Normally, the coronary arteries dilate to 4 times their size when metabolic demand increases. However, coronary arteries affected by atherosclerosis dilate less, compromising blood flow to the myocardium and causing ischemia. Abnormalities in cardiovascular function are more likely to be detected during times of stress (aka during a stress test). (679) It uses an EKG or nuclear imaging to screen for oxygenation/blood supply to the heart muscle. It determines the heart rate and blood pressures as well as the body's adaptation to stress. (742)
LDL( low-density lipoprotein ) as it realtes to CAD:
o LDL (low-density lipoprotein) is known as the "bad" cholesterol. When an excess of LDL is produced, LDL particles adhere to receptors in the arterial endothelium. Once there, macrophages ingest them which contributes to plaque formation. LDL cholesterol should remain less than 100 mg/dL in most people and under 70mg/dL for very high risk patients.
Angina pectoris Nursing dx (4 diagnosis)
o Noncompliance, ineffective management of therapeutic regimen Arrange for home care to assist with monitoring of adherence to the regimen, getting follow up appointments, reminders of upcoming monitoring, and make recommendations. o Risk for decreased cardiac perfusion The nurse immediately administers nitroglycerin, oxygen, morphine, and aspirin and obtains a 12-lead EKG. o Anxiety related to cardiac symptoms Provide information about the illness and treatment and help the patient stress reduction techniques. o Deficient knowledge Educate the patient about the illness and discuss what the patient needs to do with a recurrent episode.
Identify 3 potential complications of cardiac surgery related to decreased cardiac output.
o One potential complication is preload alterations which occur when too little blood volume returns to the heart as a result of persistent bleeding and hypovolemia. Preload can also decrease if there is a collection of fluid and blood in the pericardium (cardiac tamponade), which impedes cardiac filling. Cardiac output is altered if too much volume returns to the heart, causing fluid overload. o Another potential complication is excessive postoperative bleeding, which can lead to decreased intravascular volume, hypotension, and low cardiac output. Bleeding problems are common after cardiac surgery because of the effects of CPB, trauma from the surgery, and anticoagulation. o A third problem is afterload alterations. This occurs when the arteries are constricted as a result of postoperative hypertension or hypothermia, increasing the workload of the heart. Heart rate alterations from bradycardia, tachycardia, and dysrhythmias can lead to decreased cardiac output, and contractility can be altered in cardiac failure, MI, electrolyte imbalances, and hypoxia.
Myocardial Infarction
o Pathophysiology: Plaque ruptures and a thrombus forms, totally blocking the artery. This causes a huge imbalance between oxygen supply and demand. Ultimately, this leads to ischemia, and eventually necrosis. o Clinical manifestations: most patients will have sudden chest pain that continues even with medication or rest. Other symptoms include SOB, indigestion, nausea, anxiety, tachycardia, tachypnea, and cool, pale, and moist skin. o Treatment: Oxygen, aspirin, nitroglycerin, and morphine should be immediately given. A 12-lead EKG should be obtained within 10 minutes and cardiac biomarkers should be checked (especially troponin). A STEMI is treated with immediate PCI within 60 minutes. When PCI is not available, thombolytic therapy is indicated.
Coronary atherosclerosis- patho, manifestations, treatment
o Pathophysiology: an inflammatory response is initiated in response to injury to the vessel endothelium, which attracts inflammatory cells to the site. Fatty streaks are developed when macrophages ingest the lipids and become foam cells, depositing some lipids into the arterial wall. Once the lipids are deposited into the vessel wall, atheromas (plaques) are formed, which narrow the vessel and obstruct blood flow. A plaque can rupture and cause thrombus formation, and the thrombus can obstruct blood flow and lead to ACS or an MI. o Clinical manifestations: depending on the location and degree of narrowing, obstruction to blood flow, and formation of thrombus causes certain symptoms. Symptoms include: angina pectoris (most common), less commonly epigastric distress, pain radiating to the jaw or left arm, shortness of breath, women have atypical symptoms like indigestion, nausea, numbness, palpitations. o Treatment: Modifiable risk factors for coronary atherosclerosis are tobaccos use, cholesterol deviations, hypertension, and diabetes. So, it is important to treat these underlying conditions to treat coronary atherosclerosis. Treatments include: lowering total cholesterol, triglycerides, LDL, raising HDL, following the TLC diet if needed, quitting tobacco use, increase physical activity, managing hypertension, and controlling diabetes
Angina Pectoris
o Pathophysiology: usually always caused by atherosclerotic disease and indicates obstruction of at least one major coronary artery. Insufficient blood flow results in decreased supply when there is increased demand (the demand outweighs the supply). Factors leading to angina pain include: physical exertion, exposure to cold, eating a heavy meal, and stress or emotion. o Clinical manifestations: The pain is usually felt in the chest behind the sternum and can be localized to the neck, shoulders, jaw, and upper arms (usually left arm). Tightness or heaviness feeling is common, as well as numbness in the arms, SOB, pallor, lightheadedness, and n&v. The pain should subside with rest or nitroglycerin. Types of angina include: stable(relieved by rest or nitroglycerin), unstable (called preinfarction angina, pain frequency increases and may not be relieved with nitroglycerin or rest), intractable (incapacitating chest pain), variant (caused by vasospasm), and silent (evidence of ischemia without reports of pain). o Treatment: Overall, the goal is to decrease the demand and increase the oxygen supply. Medications such as nitroglycerin, beta blockers, calcium channel blockers, and antiplatelets are used. Oxygen is administered to increase the amount of oxygen supply. An EKG is performed as well.
What are other problems/diagnosis that cause chest pain?
o Pericarditis o Pneumonia o Pulmonary embolism o Esophageal disorders (hiatal hernia, reflux esophagitis or spasm) o Anxiety/panic disorders o Musculoskeletal disorders (costochondritis)
Based on the risk factors associated with coronary artery disease, identify areas of prevention. Include lifestyle changes in the discussion.
o Since the modifiable risk factors for CAD mostly include lifestyle/dietary changes, it is important to begin (or continue) eating healthy.. In our book it discusses the "TLC Diet". In this diet it discusses what we need most of and what we need less of. It says 25%-35% of our total calories need to come from total fat. (<7% saturated fat, up to 10% total calories of polyunsaturated, and up to 20% of total calories in monounsaturated fats). Then it tells us that 50-60% of our total calories need to come from carbohydrates, 20-30 g/d need to come from dietary fiber, approximately 15% of total calories from protein and <200 mg/d of total calories need to come from cholesterol. This diet can of course be changed to fit individual needs. o Another area of prevention is to engage in moderate-intensity aerobic activity of at least 150 minutes per week, or vigorous-intensity aerobic activity at least 75 minutes per week. Physical activity increases HDL levels and reduces triglyceride levels, decreasing the incidence of coronary events and reducing overall mortality risk. o If diet alone cannot normalize the cholesterol levels, medications can aid in that. Lipid-lowering medications can reduce CAD mortality in patients with elevated lipid levels and in at-risk patients with normal lipid levels. o One of the biggest ways to prevent CAD is too simply stop smoking. o Managing hypertension- the risk for CAD increases as the BP exceeds 120/80. So, hypertension can be managed by eating healthier, exercise, and medications o Managing Diabetes
Describe nursing management of valve replacement:
o The nurse assesses for signs and symptoms of heart failure and emboli, listens for changes in heart sounds at least every 4 hours, and provides the patient with the same care as for postprocedure cardiac cath and angioplasty. o Patient will be sent to the ICU. Care for this patient will focus on recovery from anesthesia and hemodynamic stability. o vital signs are assessed every 5-15 min and as needed until pt recovers from anesthesia or sedation and then are assessed every 2-4 hours and as needed. o Assess radial, tibial, and dorsalis pedis pulses o IV med to increase or decrease blood pressure and to treat dysrhythmias or altered heart rate are administered and effects are monitored. o Assessments are conducted every 1-4 hours and as needed, with particular attention to neurologic, respiratory, and cardiovascular systems. o After the patient has recovered from the anesthesia and come off the IV medication and is stable, the patient is transferred to the telemetry unit (usually within 24-72 hours) o Nursing care continues such as wound care, pt education, diet, activity, meds, and self care. o The nurse educated the patient on anticoagulant med and the importance of follow up appointments.
Develop nursing interventions for the patient who has undergone cardiac surgery. List rationale and expected outcomes associated with these interventions.
o There is a good plan of nursing care on pages 760-763 in our textbook. o The four interventions listed below relate to the goal of: Restoration of cardiac output to maintain organ and tissue perfusion.
Mitral valve regurgitation: patho, manifestations, management
o involves blood flowing back from the left ventricle into the left atrium during systole. Most common causes are degenerative changes of the mitral valve and ischemia of the left ventricle. o Pathophysiology- may result from problems with one or more leaflets, chordae tendinae, annulus, or papillary muscles. Regardless of cause, blood regurgitates into the atrium during systole. With each beat of the left ventricle, blood is forced back into the left atrium, adding to blood flowing in from the lungs. This causes the left atrium to stretch and eventually hypertrophy. The lungs become congested, eventually adding extra strain to the right ventricle. The volume overload causes ventricular hypertrophy. Eventually, the ventricle dilates and systolic heart failure develops. o Clinical Manifestations- Chronic mitral regurgitation is often asymptomatic. Acute mitral regurgitation usually manifests as severe congestive heart failure. Dyspnea, fatigue, and weakness are the most common symptoms. o Management- Same management as for heart failure. Patients benefit from afterload reduction by treatment with ACE inhibitors or angiotensin receptor blockers and beta blockers. Patients need to restrict his or her activity level to minimize symptoms. Symptoms are also an indicator for surgical intervention by mitral valve valvuloplasty or valve replacement.
Aortic Regurgitation: patho, manifestations, management
o is the flow of blood back into the left ventricle from the aorta during diastole. Can be caused by inflammatory lesions that deform aortic valve leaflets or dilation of the aorta, preventing complete closure of the aortic valve. o Pathophysiology- Blood from the aorta returns to the left ventricle during diastole, in addition to blood normally delivered by the left atrium. The left ventricle dilates in an attempt to accommodate the increased blood volume. It also hypertrophies in an attempt to increase muscle strength to expel more blood with above-normal force, increasing systolic blood pressure. Arteries attempt to compensate for the higher pressures by reflex vasodilation. o Clinical Manifestations- Aortic insufficiency develops without symptoms in most patients. Some patients are aware of a forceful heartbeat in the head or neck. Marked arterial pulsations visible or palpable at carotid or temporal arteries may be present as a result of increased force and volume of blood ejected from a hypertrophied left ventricle. Exertional dyspnea and fatigue follow. S/S include breathing difficulties. o Management- The patient is advised to avoid physical exertion, competitive sports, and isometric exercise. The first medications usually prescribed are vasodilators such as calcium channel blockers and ACE inhibitors.
Aortic Stenosis
o narrowing of the orifice between the left ventricle and aorta. In adults, stenosis is often a result of degenerative calcifications. o Pathophysiology- This usually occurs over several years/decades. The left ventricle overcomes obstruction to emptying by contracting more slowly but with more power than normal, forcibly squeezing blood through the smaller orifice. Obstruction to left ventricle outflow increases pressure on the left ventricle, so the ventricular wall thickens. o Clinical Manifestations- Many patients are asymptomatic. When symptoms develop, patients usually first have exertional dyspnea, caused by increased pulmonary venous pressure due to left ventricular failure. Orthopnea, PND, and pulmonary edema also may occur. Reduced blood flow to the brain may cause dizziness and syncope. Angina pectoris is a frequent symptom. o Management- Definitive treatment for aortic stenosis is surgical replacement of the aortic valve. Patients who are symptomatic and are not surgical candidates may benefit from one or two-balloon percutaneous valvuloplasty procedures with or without transcatheter aortic valve implantation.
myocardial infarction (MI)
occurs when a portion of the heart muscle no longer receives oxygen-rich blood and becomes necrotic. Most common warning symptoms of a heart attack for BOTH men and women are: chest pain or discomfort, upper body discomfort (one/both arms, the back, shoulders, neck, jaw, or epigastric region), and shortness of breath. Pain can be the very similar to the pain from angina pectoris, but more severe. Chest pain that occurs suddenly and continues despite rest and medications is the presenting symptom
What are potential complications that the nurse should be aware of when caring for the patient with hemodynamic monitoring?
pneumothorax, infection- risk after 96 hours, and air embolism- opening the system to air, this can lead to an air embolism.
Stable angina
predictable or consistent pain that occurs on exertion and is relieved with rest and/or the administration of nitroglycerin.
How calcium aids in the diagnosis of cardiovascular disease:
should be between 8.6-10.2 A low calcium can cause a decrease in coagulability and contractility in the heart leading to possible heart failure Calcium enhances the inotropic effect of digitalis and can aggravate digitalis toxicity. (258-261) A high calcium can come from thiazide diuretics. This can potentiate Digoxin toxicity, ventricular fibrillation, heart blocks, and increased contractility.
C-reactive Protein( CRP) as a marker for MI
this causes inflammation the more this occurs the higher chance of atherosclerosis. it is high if it is above 3 mg/l or greater.
Discuss the components of CABG. Page (752-755) of med surg book.
• Coronary artery bypass (CABG) is a surgical procedure in which a blood vessel is grafted to an occluded coronary artery so that blood can flow beyond the occlusion; it is also called a bypass graft. o The major indications for CABG are: Alleviation of angina that cannot be controlled with medication or PCI Treatment for left main coronary artery stenosis or multi-vessel CAD. Prevention of and treatment for MI, dysrhythmias, or heart failure. Treatment for complications from an unsuccessful PCI. o For a patient to be considered for CABG, the coronary arteries to be bypassed must have approx. 70% occlusion (60% if in the left, main coronary artery).