Cardiac System Med Surg Notes 2

Sawtooth RATE 75-150 BPM RHYTHM Usually regular P WAVE “Sawtooth” P wave configuration shaped flutter waves Similar to A-fib, but the heart’s electrical signals spread through the atria. The heart’s upper chambers (atria) beat too quickly but at a regular rhythm. PR INTERVAL Unable to measure QRS COMPLEX Usually normal & upright CAUSES MANIFESTATIONS q Coronary artery disease (CAD) q May be asymptomatic q Hypertension q Fatigue / syncope q Heart failure q Chest pain q Valvular disease q Shortness of breath q Hyperthyroidism q Low blood pressure q Chronic lung disease q Pulmonary embolism q Cardiomyopathy TREATMENT STABLE PT. UNSTABLE PT. q Drug therapy! q Cardioversion • Calcium channel blockers ! • Antiarrhythmics • Synchronized administration of shock (delivery in sync with the QRS wave). • Anticoagulants • Cardioversion is NOT defibrillation! Risk for clots! Atrial flutter causes pooling of blood in the atria = risk for clots ! defibrillation Defibrillation is only given with deadly rhythms! Left Side Think Lungs lungs = pulmonary symptoms d s welling of the legs & hands yspnea w eight gain r ales (crackles) Hypote nsion S3 Gal lop o rthopnea w eakness / fatigue n octurnal paroxysmal dyspnea i ncreased HR n agging cough (frothy, blood tinged sputum) g aining weight (2 -3 lb's a day) heart muscle The ventricle does not the venous system Stiff & non-compliant heart muscle The ventricle does not FILL properly e dema (pitting) l arge neck veins (JVD) l ethargy / fatigue irregular heart rate Spleno megaly Anorexi a n octuria g irth (Ascites) Amount of blood pumped out Amount of blood in the chamber 50% - 70% % EF Secreted when in the ventricle Enlarged heart & pulmonary infiltrates back flow, & valve problems types of HF Diet Modifications Fluid restrictions Strict I&O’s Daily weights Edema Same time Same scale Same clothes Report S&S of fluid retention Edema Weight gain Rep ort w (2-3 t. gain lbs) Spread fluids out during the day Elevate hob (Semi-Fowler’s position) Balance periods of activity & rest Age Gender Race Family history Modifiable Diabetes Obesi Hypertension Physical inactivity Smoking High cholesterol Metabolic Syndrome ISCHEMIA Inadequate blood supply to ANGINA PECTORIS Chest pain that is caused by myocardial ischemia • Chest pain w/ activity • Shortness of breath • Fatigued • LDL • HDL • Total Cholesterol • Triglycerides ECG • Assess for changes in ST segments or T waves! to the heart • Management of hypertension • Management of diabetes • Smoking cessation • Diet • Exercise • Lipid-lowering medications “Statins” • Heart-healthy diet • Physical activity • Smoking cessation Vigorous: 150 min • Stress management • Hypertension management • Diabetes management • Coronary stent / angioplasty • Coronary Artery Bypass Graft (CABG) Want LOW Levels (<100 mg/dL) Lipoprotein atty plaques develop Lipoprotein PERIPHERAL VASCULAR DISEASE (PVD) ARTERIAL DISEASE (PAD) Deoxygenated blood can’t get back to the heart. Pooling of oxygenated blood in the extremities. Narrow artery (atherosclerosis) where oxygenated blood can’t get to the distal extremities (hands & feet). Think “BAD” Ischemia & necrosis of the extremities “VEINY” “ARTS” very big pulses = warm legs a bsent pulses (cool, shiny, no hair) e dema (blood pooling) r ound, red sores irregulary shaped sores (ulcerations) t oes & feet pale or black “eschar” n o intense pain (dull, achy pain) s harp calf pain (intermittent claudication) yellow & brown ankles Gangrene? Gangrene? No! PVD is not an oxygen problem YES! This may develop because oxygenated blood is not getting to the extremities CAUSES OF BOTH Smoking • Diabetes • High cholesterol • Hypertension DX: Doppler Ultrasound or Ankle Brachial Index (ABI) KEEP VEIN OPEN! GET BLOOD MOVING! A • Medications • D ngle Arteries (Dependent position) - Aspirin or Clopidogrel • Perform daily skin care with moisturizer - Cholesterol lowering drugs “statin” • Stop smoking • Surgery • Avoid tight clothing (vasoconstriction) - Angioplasty • No heating pads! - Bypass (CABG) • Medications - Endarterectomy - Vasodilators - Antiplatelets “Preinfarction” “Coronary artery vasospasm” Occurs with Occurs at Pain at rest with reversible exertion rest st-elevation & more frequently demand for oxygen tion) may radiate to neck, jaw, or shoulders • Unusual fatigue • Weakness • Shortness of breath • Pallor Reperfusion Procedures PCI Percutaneous Coronary Interventions Calcium Channel Blockers • Vasodilators beta blockers sublingually heart Bypass Graft Antiplatelet / Anticoagulant • Relaxes blood vessels • Prevents platelet consumption • Usually administered Coronary Artery aggregation & thrombosis or more arteries of the heart artherosclerosis angina Myocardial Infarction (mI) Coronary arteries become narrow due to plaque build-up Due to ischemia (low O2) Plaque rupture become a blood clot that blocks arteries of the heart radiating chest pain that continues despite rest & medications Pain felt in the... • Shortness of breath • Left arm • Nausea & vomiting • Mid back/shoulder • Sweating • Heartburn • Pale & dusty skin • Fatigue • Shoulder blade discomfort • Shortness of breath Prevention & Rest clot buster m o n Medications • Thrombolytics (clot busters) • ST-Elevation (no O2) • ST-Depression (low O2) T-wave inversion - Troponin - Stress test • Chemical & excercise Suffixes: -teplase -ase • Example: Streptokinase Surgery • PCI “Percutaneous Coronary Intervention” • CABG • Endarterectomy - Cut out the blockage • Heparin IV Rest the heart with... • Nitro • Beta-Blockers • Calcium channel blockers Systolic Diastolic (Squeeze) (Decompress) Normal < 120 < 80 Pre-htn 120 - 139 80 - 89 Stage 1 htn 140 - 159 90 - 99 Stage 2 htn > 160 > 100 HTN crisis > 180 > 120 congestive heart failure (chf) affected organs categories Overworking of the heart muscle (ventricle enlarges) stroke Weak & narrow vessels could lead to rupture of vessels renal failure Too much blood flowing to the kidneys at a fast rate & high pressure visual changes Damages blood vessels in the retina (blurred vision, can’t focus on objects) RISK FACTORS MOST COMMON Primary HTN Also called essential or idiopathic HTN secondary HTN • Has a direct cause / preexisting condition Family HX • Chronic kidney disease • Diabetes • Hypo/Hyperthyroidism • Cushing syndrome • Pregnancy • Certain drugs (oral contraceptives) • Cause is unknown • Not curable, only controllable Race (African Americans) Intake of Na/ETOH Smoking Restricted activity Low K+ & vitamin D levels TAKING A PROPER BLOOD PRESSURE • Look for the brachial artery! SIGNS & SYMPTOMS Usually asymptomatic! Commonly called the “silent killer” • Do not smoke, exercise, drink caffeinated beverages or alcohol within 30 minutes Symptoms: • Blurred vision (if seen) • Headache • Chest pain • Nose bleeds • Instruct the client to... - Sit in a chair with legs uncrossed - Arm at level - Correct size cuff q EDUCATION • Limit sodium intake • Limit alcohol intake • Smoking cessation • NO BP in arms with.... Too small = false high BP - HX mastectomy Too large = false low BP - HX of AV shunt - Blood clots - Current IV in the arm • Teach how to measure BP & keep a record • Exercise programs for weight loss if needed ANTIHYPERTENSIVE MEDICATION OVERVIEW “ ABCDD “ SUFFIXES A B C D D ACE inhibitors -PRIL BETA Blockers -OLOL Calcium Channel Blockers -PINE -AMIL Digoxin Diuretics 752321,1 WURSRQLQ,QJP/ !   &5 QJP ,7, &$ / / ,1&5($6( 3($. )HZKRXUV &DQUHPDLQHOHYDWHGIRUDV ORQJDVZHHNV &.0% ,1&5($6( )HZKRXUV 0<2*/2%,1 ,1&5($6( +RXUV QJP/ 3($. +RXUV QJP/ 3($. +RXUV /223'LXUHWLF EXPHWDQLGH WRUVHPLGH %XPH[ 'HPDGH[ /DVL[ 2EWDLQEDVHOLQHYLWDO ,QKLELW +\SHUWHQVLRQ +\SRNDOHPLD UHDEVRUSWLRQRI +HDUWIDLOXUH +\SRWHQVLRQ 5HQDOGLVHDVH +\SRQDWUHPLD 6/2:/<UDSLGDGPFDQ (GHPD +\SHUJO\FHPLD FDXVHSHUPDQHQWKHDULQJ 3XOPRQDU\ 3KRWRVHQVLWLYW\ HGHPD 'HK\GUDWLRQ 1$&O $FWVRQVLWHV UHDEVRUSWLRQ VLJQV $GPIXURVHPLGH ORVV 5HSODFH.LIP(T/ 7+,$=,'('LXUHWLF K\GURFKORURWKLD]LGH FKORURWKLD]LGH 0LFUR]LGH 'LXULO ,QKLELW UHDEVRUSWLRQ RI1$&O ([FUHWLRQRI 1D&O +2 PHWK\FORWKLD]LGH PHWK\FORWKLD]LGH +\SHUWHQVLRQ +\SRNDOHPLD 2EWDLQEDVHOLQH +HDUWIDLOXUH +\SRWHQVLRQ YLWDOVLJQV 5HQDOGLVHDVH +\SRQDWUHPLD &LUUKRVLV /LELGR (GHPD +\SHUJO\FHPLD &RUWLFRVWHURLGV 3KRWRVHQVLWLYLW\ *LYHZPHDOVWR *,XSVHW 5HSODFH.LI P(T/ $YRLGJLYLQJWR (VWURJHQ 'HK\GUDWLRQ SWVZLWKJRXW 7KHUDS\ $]RWHPLD 0RQLWRUUHQDO IXQFWLRQ 26027,&'LXUHWLF PDQQLWRO 2VPLWURO WKHWKLFNQHVV RIWKHILOWUDWHVR ZDWHUFDQWEH 7[RI FHUHEUDO &O 0D\FU\VWDOL]HFKHFN %OXUUHGYLVLRQ HGHPD UHDEVRUEHG ([FUHWLRQRI1D (GHPD VROXWLRQEHIRUHDGP 1DXVHDYRPLWLQJ ,QWUDRFXODU 3UHVVXUH 3HUIRUPQHXUR GLDUUKHD DVVHVVPHQW/2&LI 8ULQDU\UHWHQWLRQ XVLQJIRUFHUHEUDO ,23 HGHPD .6SDULQJ'LXUHWLF VSLURQRODFWRQH $OGDFWRQH W RQ H Q RO DF 6SL UR  LQ J  . 6S DU . 1 , 7+ $QWDJRQL]HV +\SHUWHQVLRQ DOGRVWHURQH (GHPD 'LDUUKHD LQSRWDVVLXP +\SRNDOHPLD *DVWULWLV $YRLGVDOWVXEVWLWXWHV 'URZVLQHVV SRWDVVLXPVXSSOHPHQWV ZKLFK UHDEVRUSWLRQ RI1D +\SHUDOGRVWHURQLVP &URVVVH[KRUPRQDO WKHUDS\ 127. (UHFWLOHG\VIXQFWLRQ $YRLGHDWLQJIRRGVKLJK 0RQLWRU.OHYHOV *\QHFRPDVWLD ([FUHWLRQRI 1D+2 +\SHUNDOHPLD 6SLURQRODFWRQH LQKLELWV WHVWRVWHURQH (GXFDWH J\QHFRPDVWLDLV XVXDOO\UHYHUVLEOH DIWHUWKHUDS\KDV VWRSSHG