• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Cardiac PowerPoint

Cardiac PowerPoint






Total Views
Views on SlideShare
Embed Views



0 Embeds 0

No embeds



Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
Post Comment
Edit your comment

    Cardiac PowerPoint Cardiac PowerPoint Presentation Transcript

    • Cardiac/Vascular Circulation
      • Brenda Rowe, RN, MN, JD
      • Georgia Baptist College of Nursing
      • of Mercer University
    • C.O. = Stroke Vol. X Heart Rate
      • Preload - passive stretching force exerted on ventricle muscle
      • Contractility - force of the squeezing that the ventricle is able to achieve
      • Afterload - amount of pressure the ventricle muscle must overcome to eject
      • Contraction - dependent upon conduction system
    • Cardiac Effects of Digoxin
      • Positive inotropin effect: strengthens the force of contraction
      • Negative dromotropin effect: decreases conduction
      • Negative chronotropin effect: decreases heart rate
      • Improve renal perfusion
    • Digoxin * CHF, atrial fib * digitalization * toxic effects - N&V, diarrhea, green/yellow vision, double vision, headache, dizziness, fatigue, weakness * monitor effectiveness * watch for hypokalemia * education * antidote - digoxin immune FAB
    • Nursing Interventions
      • Monitor HR - apical for 1 minute
      • Monitor Dig level - 0.5-2.0 ng/ml
      • Monitor K, Calcium, Mag - increase in calcium or decrease in K or Mag will potentiate the effect of Digoxin
    • Other Cardiac Glycosides
      • inamrinone (Inocor) & milrinone (Primacor): increase force of contraction and produce a vasodilatory effect which increases cardiac output
      • Used for short term management of CHF
    • Critical Thinking Exercise
      • A patient with CHF
      • Is on Digoxin, Lasix, and potassium supplement
      • What is the desired therapeutic effect?
      • Why should hypokalemia be prevented?
      • What blood work should be monitored?
    • Nitroglycerin
      • Relaxes vascular smooth muscles & dilates arterial & venous vessels thus reducing afterload & myocardial consumption
      • Acute angina: sublingual, transmucosal, or translingual spray
      • Prophylactic for angina: above & topical & oral SR
      • IV: used to treat primarily hypertension
    • Tolerance & Adverse Effects
      • Tolerance may develop
      • Less likely in sublingual & translingual spray
      • Most common adverse effects: headache, can have hypotension, tachycardia, syncope
    • Anginal Episode
      • Have a person lie down
      • Give nitroglycerin tabs x 3, if needed, 5 minutes apart
      • If no relief – call 911
    • Education
      • Smoking causes vasoconstriction which may cause angina
      • Sublingual: keep in original bottle with tight cap
      • Transdermal: nonhairy area but avoid distal parts of extremities, remove patch for 10-12 hours
    • Education (cont.)
      • Increase absorption with broken skin, increase with exercise, increase temperature (avoid sauna)
      • Ointment: choose a different application site, use tissue to remove any old ointment, do not massage or rub in ointment
    • Antiarrhythmics * see after MI, cardiac surgery, CAD, electrolyte imbalance, thyroid disease * abnormality with initiation of impulse or in impulse conduction or both * should be monitored, most meds given IV, monitor AP (rate & rhythm)
    • Antiarrhythmic Agents Quinidine (Cardioquin) – class 1A depresses Phase 0 in depolarization * depresses cardiac function, however inhibits vagal action so may have sinus tachycardia * has high incidence of adverse effects with most common being GI * monitor renal & liver function
    • Lidocaine
      • Lidocaine (Xylocaine) - Class 1B depresses phase 0 but not as much as Quinidine
      • brief action so less chance of cumulative drug toxicity, make sure you have correct type of Lidocaine, tx ventricular arrhythmias
      • give IV
    • Antiarrhythmic Agents (cont.) Flecainide (Tambocor) - Class 1C markedly depresses phase 0, tx PAF or flutter & ventricular arrhymias, suppress conduction, many adverse effects Propranolol (Inderal) - Class II depresses phase 4 depolarization, beta adrenergic blocking agent, tx arrhythmias secondary to dig toxicity, also used to tx hypertension, angina & MI
    • amiodarone (Cordarone)
      • Amiodarone (Cordarone) - Class III prolongs phase III repolarization
      • increases refractory period, increases myocardial contractility, vasodilatory action
      • used to prophylaxis and therapy of vent fib
      • keep pt supine - most common AE is orthostatic hypotension
    • Verapamil HCL (Calan)
      • Class IV depresses phase 4 depolarization & lengthens phase 1 & 2 of repolarization
      • calcium channel blocker, decrease myocardial contraction, decrease SA node impulse, decrease conduction, also causes CA dilatation & peripheral vasodilatation
      • also used to tx angina
      • watch for bradycardia & hypotension
      • AE - most common is constipation
      • IV solution must be protected from light
      • Administer slowly – greater than 2 minutes
    • Potassium-Removing Resins
      • Sodium polystyrene sulfonate (Kayexalate)
      • oral or enema
      • AE - hypokalemia
    • Antihyperlipidemics
      • Definition
      • HDL/LDL
    • Statins
      • lovastatin (Mevacor)
      • Blocks synthesis of cholesterol in liver
      • Decrease LDL, increase HDL
    • Bile acid sequestrants
      • cholestyramine (Questran)
      • Lower LDL levels
      • Binds bile acids in intestine
    • New drugs
      • How actions differ