-
Afterload
- Affects stroke volume
- Resistance or pressure in aorta and peripheral arteries that the L ventricle must work against to eject blood from the heart.
- Vasodilation = AL decrease
- Vasoconstriction = AL increase
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Stroke Volume
- The amount of blood ejected per heart beat (70mL average)
- Determined by preload, afterload, & contractility
- Increase PL = Increase SV
- Increase AL= Decreased SV
- Increased contractility = Increased SV
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What is the direct of the blood through the heart?
- Sup/Inf Vena Cava --> R Atrium (RA)
- RA through tricuspid valve --> R Ventricle (RV)
- RV through pul. Valve --> pul. artery and lungs
- Lungs --> pul. Vein --> L Atrium (LA)
- LA through mitral valve --> L ventricle (LV)
- LV through aortic valve --> Aorta
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Which is larger Left or Right Ventricle?
Left Ventricle is usually 2.5 times larger
-
How much of the O2 from the lungs does the heart take?
-
Baroreceptors
- Specialized cells in carotid arteries and aortic arch that
- signals body to increase/decrease BP & HR
-
Preload
The degree of stretch of the ventricular cardiac muscle at the end of diastole
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Cardiac patient teaching in regards to bowel regimen
- Don’t bare down b/c of vegal nerve response (can provoke dysrhythmias & bradycardia)
- Take stool softeners
-
Desirable total cholesterol level
Below 200 mg/dL
-
Near optimal LDL cholesterol level
100-129 mg/dL
-
What is the goal for LDL and HDL cholesterol lvls?
-
Brain (B-type) Natriuretic Peptide (BNP)
- Indicator of heart failure protein released in heart failure Hormone released by heart from increase in atrial volume and ventricular pressure
- Promotes venous and arterial vasodilation
-
What should nurse ensure with patients about to undergo Cardiac Catheterization?
Ensure they are not allergic to Iodine
-
What should nurse do after Cardiac Catheterization?
- Palpate site of CC for hematoma.
- Strict bed rest 4-6 hrs
- Instruct pt. not to move leg
-
Artherosclerosis
Hardening of the arteries without atheroma (plaques)
-
What causes Angina?
- Pain caused by insufficient coronary blood flow; atherosclerosis AND increased demand for O2
- *Anxiety attack can mimic chest pain
- *Diabetics will not experience chest pain
-
Nitrates
- Vasodilator
- *Decreases myocardial oxygen consumption
-
Pt. teaching about Beta blocker induced impotence
If they have this they can switch to another type of medication
-
Glycoprotein IIb/IIIa agents
- Prevent platelet aggregation
- *Watch for s/s of bleeding*
- Eptifibatide (Integrilin)
- Abciximab (Reopro)
- Tirofiban (Aggrastat)
-
Troponin
- Accurate/reliable indicator of myocardial injury used if pt.waits > 24hrs to seek tx.
- Positive for MI if > 4
- Most sensitive indicator of MI
-
Myoglobin
- Test does not indicate if MI occurred but neg. result rules out MI
- Starts to increase 1-3 hrs, peak within 12hrs
-
MONA treatment MI
- M= Morphine; decrease pain, anxiety, workload on heart
- O= Oxygen; increased O2 will decrease workload on heart
- N= Nitrates; relieve angina pain
- A= ASA
-
Activity Restriction in regards to cardiac pt.s
Balance amount/intensity of activity to attain health benefit without causing symptoms.
-
Normal lvl for Digitalis/Digoxin
0.5-2 ng/mL
-
What does S3 or S4 heart sounds indicate?
Murmur, caused by; CAD, hypertrophy, aortic stenosis, ventricularfailure, mitral valve regurgitation
-
When is S3 heart sound heard?
After S2
-
When is S4 heart sound heard?
Before S1
-
Fibrous plaque associated with Coronary Artery Disease
- Progressive change in the arterial wall
- Normally endothelium cells repair themselves instantly, but with CAD endothelium cells slow repair allows LDL to thicken arterial wall.
-
Acute Coronary Syndrome (ACS)
Umbrella term for any symptoms of acute MI
-
Myocardial Infarction
- Results from sustained ischemia (>20 min)
- Irreversible myocardial cell death
- Occurs when coronary artery is occluded or in a vasospasm
- Cells eventually die from hypoxia
-
Initial treatment for MI
- ECG, monitor VS, lab studies
- Decrease cardiac workload and anxiety
-
S/S of Left-sided heart failure
- Dyspnea
- Decrease O2 sats
- HTN
- Tachycardia & tachypnea
-
S/S of Right-sided heart failure
Jugular vein distention
-
Why should nurse complete daily weights on cardiac patients?
To assess changes in fluid volume
-
Cardiac patient discharge teaching (as per Joint commission)
- Daily weights
- What to do if symptoms return
- Diet
- Activity
- Medications
-
S/S of Peripheral Arterial Disease (PAD)
- Thin, shiny, taught skin
- Loss of hair on lower legs
- Diminished/absent peripheral pulses
- Pallor of the feet, uneven peripheral pulses bi-lateral
-
Cluadication
- Symptom of PAD
- Pain caused by too little blood flow generally in legs when
- exercising
-
Treatment for claudication
Walk 30-60 minutes per day or until pain discomfort begins
-
General care for PAD
- Protect from trauma
- Wear well-fitting shoes
- Avoid tight-fitting socks
-
Buerger’s Disease
- Inflammatory disease involving fingers where blood vessel become blocked
- Most often associated with smoking
- *Treatment is to stop smoking*
-
Causes of venous thrombosis
- *Prolonged immobility* and other stasis of blood
- Trauma to vein
- Hypercoagulability
-
What must be monitored with administration of Warfarin (Coumadin)?
-
How to diagnose HTN
Requires at least 3 elevated readings over several weeks
-
Lifestyle modification for pt.s with HTN
- *Self monitor BP*
- Weight loss
- Reduce sodium
- Regular physical activity
-
Medication education for HTN patients
- Names, actions, doses, side effects of all drugs
- Do not abruptly d/c
- Never double-up to account for a missed dose
- Watch for orthostatic hypotension
- Monitor OTC ingredients
-
Substances that shouldn’t be in urine
- Protein (trace amount ok)
- Glucose
- Blood (trace ok)
-
Renin-Angiotension System
- Vasa Recta in kidneys detect a decrease in BP
- Low BP stimulates renin secretion
- Renin converts angiotensin to angiotensin I
- ACE from lungs converts angiotensin I to II
- Vasa Recta senses increase in BP and secretion of rennin ceases
-
-
Oliguria
Very little urine output (<30 mL/hr)
-
Glomerulonephritis
- Inflammation of the glomerular capillaries;
- Acute = acute nephritic syndrome
- Chronic
-
Clinical manifestations of Glomerulonephritis
- HTN, Weight loss, Azotemia
- *Dark red or “cola” colored urine
- *check daily weights*
-
Azotemia
Abnormally high levels of nitrogen-containing compounds in urine
-
Clinical manifestations of acute renal failure
- Oliguria(decrease lvl of urine output)
- Anuria (very little to no urine output)
- Azotemia (highlvl of nitrogen compounds in urine)
-
Types of urinary incontinence
- Stress- intacturethra (sneeze, laugh)
- Urge- strong urgebut unable to reach toilet in time
- Reflex- bladder empties w/o any control
- Overflow- weak muscle
- Functional- no muscle weakness, physical/mental limits
- Iatrogenic- incontinence effected by medication/intrinsic factors
-
Clinical manifestation of Nephrotic Syndrome
- Proteinuria
- Edema;periorbital, ascites
-
Common side effect of loop diuretics
- Depletion of water, sodium, potassium
- Postural hypotension
-
Atypical symptoms of acute Coronary Syndrome (ACS)
- Absencein pain
- Palpitations
- Feelingsof doom
- Anxiety
-
Phases of cardiac rehab
- Phase1: Inpatient; measures abilities, light walking, pt. & family education of lifestyle changes
- Phase2: Closely supervised ambulatory outpatient program
- Phase3: Lifetime maintenance
-
What is a distinguishing characteristic of dilated cardiomyopathy?
- Also know as congestive, the heart is enlarged and weak
- Ventricular dilation w/o increase size of muscle
- *Exertion dyspnea*
-
What are clinical manifestations of restrictive cardiomyopathy?
- Fatigue
- Swollen feet/hands
- Dyspnea w/ exertion
-
Manifestation of Raynaud’s Disease
- Skin color goes;
- white --> blue --> red
-
How can you prevent complications of venous insufficiency?
- Elevate legs q2 hrs for15 min
- Sleepwith feet raised 6 inches
- Compression stockings
- Avoid prolonged sitting/ cross legs/ tight clothes & socks Monitorskin daily
-
Prevention of varicose veins
- Don’t stand for extended periods of time
- Walk to promote circulation
- Tedhose
-
Primary HTN
- Most common
- Unable to determine single cause for increase BP
- Idiopathic
-
What can you do to prevent UTI?
- *Drink plenty of fluids*
- Hygiene
-
Clinical manifestations of UTI in elderly
- Confusion/altered mental status
- Incontenance
-
Extracorporeal shock wave lithotripsy (ESWL)
- Non-invasive procedure that blasts kidney stones with shockwaves to break them up.
- Used for stones too large to pass through ureters
-
Patient teaching about Phosphorus-binding medications
Take with food
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