Cardiovascular
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Cardiovascular Cardiovascular Presentation Transcript

  • cardiovascular
  • Disorders
  • Coronary Artery Disease (CAD)
    • Accumulation of fatty deposits in the inner layer of coronary arteries.
    • due to hypercholesterolemia
    • Incomplete occlusion of the coronary arteries lead to Angina (ischemia)
    • Complete occlusion of the coronary arteries lead to Myocardial Infarction
    • Manifestations depend on the severity of coronary arterial occlusion
  • Risk Factors
    • Age above 45/55
    • Sex- Males and post-menopausal females
    • Race
    • Family History
    • Hypertension
    • Cigarette Smoking
    • Diabetes Mellitus
    • Obesity
    • Sedentary Lifestyle
    • Stress
    • Atherosclerosis
  • Pathophysiology
    • Fatty streak formation in the vascular intima  T-cells and monocytes ingest lipids in the area of deposition  atheroma  narrowing of the arterial lumen  reduced coronary blood flow  myocardial ischemia
  • Angina
    • Chest pain resulting from coronary atherosclerosis or myocardial ischemia
    • Types:
    • Stable – exertional; relieved by rest, drugs; severity does not change
    • Unstable – Occurs unpredictably during exertion and emotion; severity increases with time and pain may not be relieved by rest and drug
    • Prinzmetal (variant) – pain at rest with vasospasm
  • Manifestations
    • Characteristic of chest pain
    • - Substernal or retrosternal pain that radiates to arms, shoulders, back, neck and jaws
    • - Squeezing, heavy, burning, tight chest
    • - Precipitated by cold, eating, emotions, exertion
    • - Lasts a few minutes and then subsides
    • Diaphoresis
    • Nausea and vomiting
    • Cold clammy skin
    • Sense of apprehension and doom
    • Dizziness and syncope
  • Diagnostic Tests
    • NTG test (relief from pain)
    • ECG (ST depression and T wave elevation)
    • Cardiac catheter – atherosclerotic lesions
    • Thallium 201 Imaging
    • Technetium Imaging
  • Nursing Diagnosis
    • Pain related to imbalance in myocardial oxygen demand
    • Decreased cardiac output related to reduced preload and afterload
    • Anxiety related to pain, uncertain prognosis and threatening environment
  • Management
    • Relieve pain
    • Place in comfortable position
    • Administer O2
    • Decrease Anxiety
    • PTCA - percutaneous transluminal coronary angioplasty
      • To compress the plaque against the vessel wall, increasing the arterial lumen
    • CABG - coronary artery bypass graft
      • To improve the blood flow to the myocardial tissue
    • Explain the reasons for hospitalization, diagnostic tests and therapies
  •  
    • Give antianginal drugs
    • Aspirin- prevent thrombus formation
    • Beta-blockers- reduce BP and HR
    • Calcium-channel blockers- dilate coronary artery and reduce vasospasm
    • Nitrates- to dilate the coronary arteries
    • Put one nitroglycerin tablet under the tongue
    • Wait for 5 minutes
    • If not relieved, take another tablet and wait for 5 minutes
    • Another tablet can be taken (third tablet)
    • If unrelieved after THREE tablets  seek medical attention
  • Myocardial Infarction
    • Absence of O2 supply to the myocardium
    • Necrosis or death to the myocardial tissue
    • Attack may be sudden or gradual
  • Etiology
    • 1. CAD
    • 2. Coronary vasospasm
    • 3. Coronary artery occlusion by embolus and thrombus
    • 4. Conditions that decrease perfusion- hemorrhage, shock
  • Risk factors
    • 1. Hypercholesterolemia
    • 2. Smoking
    • 3. Hypertension
    • 4. Obesity
    • 5. Stress
    • 6. Sedentary lifestyle
  • Pathophysiology
    • Interrupted coronary blood flow  myocardial ischemia  anaerobic myocardial metabolism for several hours  myocardial death  depressed cardiac function  triggers autonomic nervous system response  further imbalance of myocardial O2 demand and supply
    • Chest pain:
    • Severe, steady crushing and squeezing substernal pain
    • Radiates to the neck, arm, jaw and back
    • Not relieved by rest or NTG
    • May continue for 15-30 minutes
    • May produce anxiety and fear resulting to increased HR, BP and RR
    • dyspnea
    • Diaphoresis
    • cold clammy skin
    • N/V
    • restlessness, sense of doom
    • tachycardia or bradycardia
    • hypotension
    • dysrhythmias
  •  
  • Diagnostic Evaluation
    • Chest pain cannt be relieved by NTG
    • ST segment elevation and T wave inversion, Q wave
    • Cardiac enzymes: increased
    • Troponin, CK MB, LDH
    • CBC- may show elevated WBC count
  • The Cardiovascular System LABORATORY PROCEDURES
    • CARDIAC Proteins and enzymes
    • CK- MB ( creatine kinase)
      • Elevates in MI within 4 hours, peaks in 24 hours and then declines till 3 days
  • The Cardiovascular System LABORATORY PROCEDURES
    • CARDIAC Proteins and enzymes
    • CK- MB ( creatine kinase)
      • Normal value is 0-7 U/L
  • The Cardiovascular System LABORATORY PROCEDURES
    • CARDIAC Proteins and enzymes
    • Lactic Dehydrogenase (LDH)
      • Elevates in MI in 24 hours, peaks in 48-72 hours
      • Normally LDH1 is greater than LDH2
  • The Cardiovascular System LABORATORY PROCEDURES
    • CARDIAC Proteins and enzymes
    • Lactic Dehydrogenase (LDH)
      • MI- LDH2 greater than LDH1 (flipped LDH pattern)
      • Normal value is 70-200 IU/L
  • The Cardiovascular System LABORATORY PROCEDURES
    • CARDIAC Proteins and enzymes
    • Myoglobin
    • Rises within 1-3 hours
    • Peaks in 4-12 hours
    • Returns to normal in a day
  • The Cardiovascular System LABORATORY PROCEDURES
    • Troponin I and T
    • Troponin I is usually utilized for MI
    • Elevates within 3-4 hours, peaks in 4-24 hours and persists for 7 days to 3 weeks!
    • Normal value for Troponin I is less than 0.6 ng/mL
  • The Cardiovascular System LABORATORY PROCEDURES
    • Troponin I and T
    • REMEMBER to AVOID IM injections before obtaining blood sample!
    • Early and late diagnosis can be made!
  • The Cardiovascular System LABORATORY PROCEDURES
    • SERUM LIPIDS
    • Lipid profile measures the serum cholesterol, triglycerides and lipoprotein levels
    • Cholesterol= 200 mg/dL
    • Triglycerides- 40- 150 mg/dL
  • The Cardiovascular System LABORATORY PROCEDURES
    • SERUM LIPIDS
    • LDL- 130 mg/dL
    • HDL- 30-70- mg/dL
    • NPO post midnight (usually 12 hours)
  • The Cardiovascular System LABORATORY PROCEDURES
    • ELECTROCARDIOGRAM (ECG)
    • A non-invasive procedure that evaluates the electrical activity of the heart
    • Electrodes and wires are attached to the patient
  •  
  • The Cardiovascular System LABORATORY PROCEDURES
    • Holter Monitoring
    • A non-invasive test in which the client wears a Holter monitor and an ECG tracing recorded continuously over a period of 24 hours
  •  
  • The Cardiovascular System LABORATORY PROCEDURES
    • ECHOCARDIOGRAM
    • Non-invasive test that studies the structural and functional changes of the heart with the use of ultrasound
    • No special preparation is needed
  •  
  • The Cardiovascular System LABORATORY PROCEDURES
    • Stress Test
    • Pre-test: consent may be required, adequate rest , eat a light meal or fast for 4 hours and avoid smoking, alcohol and caffeine
  • The Cardiovascular System LABORATORY PROCEDURES
    • Post-test: instruct client to notify the physician if any chest pain, dizziness or shortness of breath . Instruct client to avoid taking a hot shower for 10-12 hours after the test
  • The Cardiovascular System LABORATORY PROCEDURES
    • Pharmacological stress test
    • Use of dipyridamole
    • Maximally dilates coronary artery
    • Side-effect: flushing of face
  • The Cardiovascular System LABORATORY PROCEDURES
    • Pharmacological stress test
    • Pre-test: 4 hours fasting, avoid alcohol, caffeine
    • Post test: report symptoms of chest pain
  • Nursing Diagnosis
    • Pain related to an imbalance in oxygen supply and demand
    • Anxiety related to chest pain, fear of death and threatening environment
    • Decreased cardiac output related to impaired contraction of the heart
    • Altered tissue perfusion (myocardial) related to coronary stenosis
    • Activity intolerance related to insufficient oxygenation
    • Risk for injury (bleeding) related to dissolution of clots
    • Ineffective individual coping related to threats to self esteem
  • Management
    • Oxygen therapy
    • Provide adequate rest periods
    • Minimize metabolic demands
      • Provide soft diet
      • Provide a low-sodium, low cholesterol and low fat diet
      • Passive ROM
    • Minimize anxiety
      • Reassure client and provide information as needed
    • Check fluids – overload is dangerous if CO is compromised
    • Avoid anaerobic exercise and exposure to cold
    • Post-MI: recognize risk of sensory overload
  • Pharmacologic Therapy
    • Thrombolytic agents - Dissolve clots in the coronary artery allowing blood to flow
    • ie TPA tissue plasminogen activator (Alteplase), Streptokinase (streptase), Urokinase
    • * S/E: bleeding and urticaria
    • Have aminocaproic acid ready( fibrinolysis inhibitor)
    • Anticoagulant – prevents formation of new blood clots
    • ie Heparin, Warfarin
    • S/S: fever, chills(hypersensitivity), rash, bleeding, diarrhea
    • Monitor blood work (INR, PT-warfarin, PTT-heparin)
    • Avoid ASA and invasive procedures
    • Bleeding precautions
    • Subcutaneous heparin- abdomen, do not aspirate or massage
    • antidotes:
    • Antiplatelet – hypersensitivity to aspirin
    • ie Ticlopidine, Clopidogrel
    • Beta adrenergic blocking agents – reduce myocardial O2 demand by blocking sympathetic stimulation; dec HR, contractility, BP ie Propranolol
    • Calcium channel blockers – dec contraction, HR; relax blood vessels ie Diltiazem
      • Morphine - reduces pain and anxiety
      • - Relaxes bronchioles to enhance oxygenation
      • ACE Inhibitors - Prevents formation of angiotensin II w/c causes vasoconstriction; dec O2 demand
      • Limits the area of infarction
    • Antihyperlipidemics- lowers serum lipids by decreasing triglycerides or cholesterol
    • Ex. HMG-CoA reductase( statins), Fibrates( Gemfibrozil), bile acid sequestrants( cholestyramine)
    • S/E: N/V, diarrhea, musculskeletal injury, hepatic toxicity, rash, reduced absorption of fat and fat-soluble vitamins. Visual disturbances(lovastatin & gemfibrozil)
    • Administer statins at HS to inc absorption, other meds wt meals to dec GI irritation, cholestyramine shld be mixed wt full glass of liquid
    • Surgical revascularization:
    • Percutaneous Transluminal Coronary Angioplasty (PTCA);
    • coronary artery bypass graft (CABG ) After the condition had been stabilized:
    • - CBR without BP (complete bedrest without bathroom privilege)
    • - Gradual resumption of ADL to full recovery
    • 1. Give 1 example of preloader
    • 2. Aspirin toxicity is manifested by
    • a. laryngitis c. hepatotoxicity
    • b. Tinnitus d. ear ache
    • 3. Captopril can ______ the TPR
    • aIncreases
    • b. Decreases
    • c. No effect
    • 4. What is the pacemaker of the heart?
    • a. SA node c. node of ranvier
    • b. AV node d. bundle of his
    • 5. Nitrates is best stored in
    • refrigerator
    • Amber colored glass
    • In open containers
    • The garden
    • 6. A patient complained of chest pain. This is true angina if the ECG reading showed
    • a.ST depression
    • b. ST elevation
    • c. Q wave invertion
    • d. T wave invertion
    • 7. IM injections should be avoided_____ taking cardiac enzymes specimen
    • a. Before
    • b. After
    • c. never
    • 8. Thrombolytic agents are given in MI. What is the antidote
    • Aminocaproic acid
    • Aminobutyric acid
    • Protamine sulfate
    • Vt. K
    • 9. Partial occlusion usually results in
    • Ischemia
    • Infarction
    • Necrosis
    • death
    • 10. This is a type of angina felt at rest ,caused by vasospasm
    • Stable
    • Variant
    • Unstable
    • Semi-stable
  • Congestive Heart Failure CHF
    • A syndrome of congestion of both pulmonary and systemic circulation caused by inadequate cardiac function and inadequate cardiac output to meet the metabolic demands of tissues
  • Predisposing Factors
    • Myocardial Infarction
    • Arrhythmias
    • Pregnancy
    • Pulmonary Embolism
    • Anemia
    • Renal Failure
    • CAD
    • Valvular heart diseases
    • Hypertension
    • Cardiomyopathy
    • Pericarditis and cardiac tamponade
  • New York Heart Association
    • Class 1
    • Ordinary physical activity does NOT cause chest pain and fatigue
    • No pulmonary congestion
    • Asymptomatic
    • NO limitation of ADLs
    • Class 2
    • SLIGHT limitation of ADLs
    • NO symptom at rest
    • Symptom with INCREASED activity
    • Basilar crackles and S3
    • Class 3
    • Markedly limitation on ADLs
    • Comfortable at rest BUT symptoms present in LESS than ordinary activity
    • Class 4
    • SYMPTOMS are present at rest
  • PATHOPHYSIOLOGY
    • LEFT Ventricular pump failure  back up of blood into the pulmonary veins  increased pulmonary capillary pressure  pulmonary congestion
    • LEFT ventricular failure  decreased cardiac output  decreased perfusion to the brain, kidney and other tissues  oliguria, dizziness
  • PATHOPHYSIOLOGY
    • RIGHT ventricular failure  blood pooling in the venous circulation  increased hydrostatic pressure  peripheral edema
    • RIGHT ventricular failure  blood pooling  venous congestion in the kidney, liver and GIT
  • LEFT SIDED CHF ASSESSMENT FINDINGS
    • 1. Dyspnea on exertion
    • 2. PND
    • 3. Orthopnea
    • 4. Pulmonary crackles/rales
    • 5. cough with Pinkish, frothy sputum
    • 6. Tachycardia
    • 7. Cool extremities
    • 8. Cyanosis
    • 9. decreased peripheral pulses
    • 10. Fatigue
    • 11. Oliguria
    • 12. signs of cerebral anoxia
  • RIGHT SIDED CHF ASSESSMENT FINDINGS
    • 1. Peripheral dependent, pitting edema
    • 2. Weight gain
    • 3. Distended neck vein
    • 4. hepatomegaly
    • 5. Ascites
    • 6. Body weakness
    • 7. Anorexia, nausea
    • 8. Pulsus alternans
  • Diagnostics
    • EKG - heart strain
    • Chest X-ray - cardiomegaly and pleural effusion
    • CVC Central Venous Catheter and Swan-Ganz Catheter are able to record high pressure in the chambers and pulmonary capillaries.
    • Echocardiogram may show hypokinetic heart
    • ABG and Pulse oximetry may show decreased O2 saturation
  • Nursing Considerations
    • goal of treatment - improve pump function and reverse the compensatory mechanism of the heart.
    • complete bed rest and reduce myocardial oxygen demand.
    • FVE management and prevent complications
    • Diuretics and Digoxin, vasodilators and hypolipidemics
    • LOW sodium diet
    • Limit fluid intake
    • Monitor daily weight and report signs of fluid retention
    • Complications:
    • Acute Pulmonary Edema
    • Treatment:
    • Bed rest and maintain high fowler’s position
    • O2 therapy
    • Morphine administration to dilate blood vessels
    • Dopamine to increase myocardial contractility and ↑ CO
    • Diuretics to reduce blood volume
    • Steroids to reduce inflammation
  • Shock
    • Hypovolemic- occurs 2 to loss of fluid resulting in decrease perfusion
    • Neurogenic- caused by rapid vasodilation and subsequent pooling of blood within the peripheral system( drugs, spinal anesthesia etc)
    • Anaphylactic- caused by an allergic reaction which cause histamine release-vasodilation
    • Septic-2 to infection which cause plasma leakage
  • CARDIOGENIC SHOCK
    • Heart fails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion
    • ETIOLOGY
    • Massive MI
    • Severe CHF
    • Cardiomyopathy
    • Cardiac trauma
    • Cardiac tamponade
  • ASSESSMENT FINDINGS
    • HYPOTENSION
    • oliguria (less than 30 ml/hour)
    • tachycardia
    • narrow pulse pressure
    • weak peripheral pulses
    • cold clammy skin
    • changes in sensorium/LOC
    • pulmonary congestion
  • LABORATORY FINDINGS
    • Increased CVP
      • Normal is 4-10 cmH2O
  • Management
    • modified Trendelenburg (shock ) position
    • IVF, vasopressors and inotropics such as DOPAMINE and DOBUTAMINE, diuretics, nitrates
    • Administer O2
    • Morphine is administered to decrease pulmonary congestion and to relieve pain
    • Assist in intubation, mechanical ventilation, PTCA, CABG, insertion of Swan-Ganz cath and IABP
    • Monitor urinary output, BP and pulses
  • CARDIAC TAMPONADE
    • heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)
    • restricts ventricular filling resulting to decreased cardiac output
    • Acute tamponade - sudden accumulation of more than 50 ml fluid in the pericardial sac
  • Risk Factors
    • Cardiac trauma
    • Complication of Myocardial infarction
    • Pericarditis
    • Cancer metastasis
  • Manifestations
    • BECK’s Triad- Jugular vein distention, hypotension and distant/muffled heart sound
    • Pulsus paradoxus
    • Increased CVP
    • decreased cardiac output
    • Syncope
    • anxiety
    • dyspnea
    • Percussion- Flatness across the ant. chest
  • Diagnostics
    • Echocardiogram
    • CXR
  • Management
    • Assist in PERICARDIOCENTESIS
    • Administer IVF
    • Monitor ECG, urine output and BP
    • Monitor for recurrence of tamponade
  • Vascular Disorders
    • Venous Thrombosis
    • CVI
    • Arterosclerosis
    • Raynaud’s Phenomenon
    • Aneurysm
    • Hypertension
  • Venous Thrombosis
    • Due to:
    • Stasis of blood
    • Injury to the vessel wall
    • Altered blood coagulation
    • High Risk:
    • Fractures, cast and joint replacement
    • Obesity and smoking
    • Immobilized patient
    • Heart problems
    • May progress to:
    • Phlebitis-inflammation of the vessel wall
    • Superficial thrombophlebitis - greater and lesser saphenous veins affected.
    • Deep vein thrombosis - deep veins affected; pulmonary embolism is a complication
  • Manifestations
    • (+) Homan’s sign
    • fever and chills
    • swelling and cyanosis of the affected leg/arm
    • Diagnostics:
    • Venous duplex ultrasound
    • Impedance plethysmography
    • RF testing (radioactive fibrinogen) fibrinogen I 125
    • Venography
    • Coagulation Profiles:
    • APTT, PT/INR
  • Management
    • Prevent complications
    • Bed rest for 5 days
    • Prevent muscle contraction if possible to prevent dislodging the clot
    • Elevation of affected part 10-20 degree above the heart
    • Anti-embolic stockings
    • Anticoagulant
    • Thrombolytic
    • Green-field filter (IVC)
    • Thrombectomy
  • Chronic Venous Insufficiency
    • Destruction of the valves because of chronic blood pooling or trauma.
    • Venous return is decreased ↓
    • chronic venous stasis ↓
    • edema formation ↓
    • veins becomes distorted or tortuous (varicosities) ↓
    • stasis ulcer, cellulites and recurrent thrombosis manifest later
  • Manifestations
    • Edema
    • Altered pigmentation
    • Pain
    • Stasis dermatitis
    • Dilated superficial veins
    • Stasis ulcers
  • Management
    • Elevate legs
    • Elastic compression stockings
    • Skin should be kept clean and dry
  • Raynaud’s Phenomenon
    • Arteriolar vasospastic disease with unusual sensitivity to cold or emotional stress.
    • cause is unknown but may be secondary to Autoimmune Diseases
  • ASSESSMENT
    • Pallor then cyanosis
    • Hyperemia when blood returns to digits after vasospasm
    • Numbness, tingling and burning pain
  • Management
    • Avoid primary stimuli (cold, tobacco)
    • Ca channel blocker
    • Nifedipine for vasospasm
    • Safety measures
  • Arteriosclerosis
    • hardening of the arterial blood vessel walls related to aging.
    • Atherosclerosis-common type of arteriosclerosis due to atheromas.
    • Aging and atheromas ↓
    • impeding the lumen of the arterial walls
    • (incomplete or incomplete occlusions ) ↓
    • systemic effects depending on the
    • blood vessel affected ↓
    • asymptomatic or may manifest if damaged is obvious ↓
    • systemic effects ↓
    • ↑ PVR to heart strain to hypertension
    • weakening the muscles of the wall that leads to aneurysm
    • TIA to CVA
    • Angina to MI
    • ATN to Renal Failure
    • Retinopathy to Blindness
    • Peripheral Occlusive Disease (TAO) to Gangrene Formation
    • Hepatic Infarction
    • Pulmonary Infarction
  • Diagnostic Evaluation:
    • Arteriography
    • CT Scan
    • MRI
    • Duplex UTZ
    • EKG
  • Management:
    • Modification of risk factors (CAD and hyperlipidemia)
    • Anticoagulants
    • Antiplatelets
    • Lipid Lowering Agent
    • Antihypertensive
    • Vascular Rehabilitation/Exercise
  • Surgical Intervention:
    • PTA-Percutaneous Transluminal Angioplasty-introduce a balloon-tipped catheter to the stenosis to reduce or eliminate the obstruction
    • Laser Angioplasty- vaporizes the plaque
    • Embolectomy-removal of clot from the artery
    • Thrombectomy-removal of thrombus from the artery
    • Endarterectomy-removal of plaque from the artery
    • Bypass Graft
  • Aneurysm
    • Dilation involving an artery formed at a weak point in the vessel wall
    • Saccular= when one side of the vessel is affected
    • Fusiform= when the entire segment becomes dilated
  • RISK FACTORS
    • Atherosclerosis
    • Infection= syphilis
    • Connective tissue disorder
    • Genetic disorder= Marfan’s Syndrome
  • PATHOPHYSIOLOGY
    • Damage to the intima and media  weakness  outpouching
    • Dissecting aneurysm  tear in the intima and media with dissection of blood through the layers
  • Manifestations:
    • Asymptomatic
    • Pulsatile sensation on the abdomen
    • bruit
    • Diagnostics
    • CT scan
    • Ultrasound
    • X-ray
    • Aortography
  • Management
    • Anti-hypertensives
    • Synthetic graft
    • Nsg:
    • Administer medications
    • Emphasize the need to avoid increased abdominal pressure
    • No deep abdominal palpation
    • Remind patient the need for serial ultrasound to detect diameter changes
  • Hypertension
    • “ Silent killer”
    • disease of vascular regulation that leads to high blood pressure
    • due to alteration of Central Nervous System, Renin-Angiotensin-Aldosterone System, Extracellular Fluid Volume
  • Primary or Essential Hypertension
    • Other causes are absent
    • Average BP exceeds the upper limits (taken at rest 3x with several days interval)
    • Diastolic is 90 mm Hg or higher
    • Represents 95% of patients with hypertension
  • Secondary Hypertension
    • Due to:
    • Renal Pathology
    • Coarctation of the Aorta
    • Endocrine Disturbance
    • Drugs (estrogens, sympathomimetics, NSAIDs, steroids)
    • Malignant Hypertension
    • It is a combination of both which is BP is uncontrolled.
  • Risk Factors
    • Old age
    • male
    • Race
    • Overweight
    • Family History
    • Smoking
    • Sedentary Lifestyle
    • Diabetes Mellitus
  • Manifestations
    • 1. Headache
    • 2. Visual changes
    • 3. chest pain
    • 4. dizziness
    • 5. N/V
  • Diagnostic Evaluation
    • Monitor BP
    • EKG, Blood Sugar, Blood Chem etc.
    • Management:
    • Control of all risk factors:.
      • Lose weight, limit alcohol, cut sodium to 2.4 g/day,
      • stop smoking, reduce dietary saturated fat and cholesterol, reduce coffee intake.
      • Despite lifestyle changes and BP remains high drug therapy should be started:
    • Diuretics
    • Beta blockers
    • Calcium channel blockers
    • ACE inhibitors
    • A2 Receptor blockers
    • Vasodilators
  • Nursing Management
    • Health teaching on:
      • Lifestyle changes ie activities, nutrition, weight, diet (low fat, low Na), cessation of smoking
      • treatment regimen ie drugs
      • BP monitoring
      • Follow up
  • Cardiovascular Drugs :
    • Anti Anginal
      • Opiate Analgesic – Morphine Sulfate
      • ↓ cardiac workload and BP, improve LOC and sedative effect
    • Vasodilators
      • Nitroglycerin NTG, hydralazine, nitroprusside
      • Relax smooth muscle, dec. BP and alleviate headache
      • Increase blood vessel diameter and improves blood flow
    • S.E. – dizziness and flushing, B6, B12 dec
    • Can be given SL or IV (Isordil) and topical (Nitrobid)
    • Calcium Channel Blockers
      • Nifidepine (Procardia) Diazepam (Cardizem)
      • Decrease muscle tone, interferes contraction, decrease BP
      • S.E. – bradycardia, diarrhea and rashes
    • Beta Blocking Agent
      • Propranolol
      • Decrease workload
      • Blocks beta receptors and capable of decreasing HR
    • S.E. – vomiting, nausea and depression
    • Diuretics- K- waster, sparer
    • S/E: hyponatremia, GI irritration, hyperurecemia, hypomagnesemia, dec. Ziinc( except K- sparers)
    • Furosemide- competes w/ ASA for renal excretion—inc. ASA levels
    • Hypocalcemia- sparers (spirinolactone, amiloride, triamterene)
    • Thiazides and loop diuretics- hyperglycemia in pxs w/ DM
    • All drugs are better administered in AM
    • Digitalis, Digoxin
    • - Positive Inotropic (Increases contraction of the heart)
    • - Increase emptying capacity of the heart
    • - Negative chronotropic (Decreases HR) AV node control
    • - Increase CO (improves stroke volume)
    • S.E. – GIT disturbance, CNS depression and flashes of light
    • Dopamine – diuresis effect
    • - Increase Na excretion (kidney)
    • Dobutamine
    • - Increase CO
    • - More potent on contraction
    • Anti dysrhythmic drug
      • Lidocaine (Xylocaine) for PVC
      • Atropine for Mobitz type I
      • Isoproterenol (Isuprel) for sinus bradycardia
      • Norepinephrine (Levophed) powerful vasoconstrictor
      • Epinephrine – increase conduction, contractility and automaticity
      • Quinidine for atrial fib
    • Thrombolytic/Fibrinolytic Agent
    • - Streptokinase – lyses the clot (20T IU IV bolus or 4T IU/min drip)
    • - Urokinase – avtivates plasminogen to plasmin (intracoronary)
    • Blood thinner
      • Heparin – prevent formation of new clot (4-8T IU/30 min)
    • Antidote – Protamine Sulfate
    • Warfarin (Coumadine) – decrease viscosity of blood (PO) home meds
    • Don’t give to pregnant women
    • Antidote – Vitamin K
  • Cardiac catheterization
  • The Cardiovascular System LABORATORY PROCEDURES
    • Pretest: Ensure Consent, assess for allergy to seafood and iodine, NPO, document weight and height, baseline VS, blood tests and document the peripheral pulses
  • The Cardiovascular System LABORATORY PROCEDURES
    • Pretest: Fast for 8-12 hours, teachings, medications to allay anxiety
  • The Cardiovascular System LABORATORY PROCEDURES
    • Intra-test: inform patient of a fluttery feeling as the catheter passes through the heart; inform the patient that a feeling of warmth and metallic taste may occur when dye is administered
  • The Cardiovascular System LABORATORY PROCEDURES
    • Post-test: Monitor VS and cardiac rhythm
    • Monitor peripheral pulses, color and warmth and sensation of the extremity distal to insertion site
    • Maintain sandbag to the insertion site if required to maintain pressure
    • Monitor for bleeding and hematoma formation
  • The Cardiovascular System LABORATORY PROCEDURES
    • Maintain strict bed rest for 6-12 hours
    • Client may turn from side to side but bed should not be elevated more than 30 degrees and legs always straight
    • Encourage fluid intake to flush out the dye
    • Immobilize the arm if the antecubital vein is used
    • Monitor for dye allergy
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  • Thank You!