Cardiac

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Cardiac

  1. 1.  Ms. Sophie is a 74 year old female who will be admitted to your floor for complaint of shortness of breath with activity and wound on left ankle. She reports a regular diet of fast food, potato chips, and chocolate. Loves salty food. She also states that she often feels stressed and depressed because of her weight however, she eats ice cream when she gets stressed. She does not exercise and often feels very tired. She has had two toes amputated from her left foot and she complains that her feet “fall asleep” easily. Patient states “feet look puffy.” She also has “moments” of chest pain. She walks with a cane.
  2. 2. Smoker High cholesterol Diabetes MI x 3 years Cardiac stent DNR CHF Angina PVD CAD HTN PTCA Meds: Furosemide, Nitroglycerin,Captopril, Metoprolol
  3. 3.  Smoker - ↑BP, dysrhythmia, PVD  High Cholesterol – occlusion of arteries  Diabetes - ↑risk of MI & CVA (TIA)  MI – ischemia, damage
  4. 4.  Cardiac stent – open occluded artery  CHF – Left sided Lungs Right sided Rest of body  Angina – chest pain associated with ↓coronary artery blood flow  PVD - ↑thrombus
  5. 5.  HTN – sex, aging, HX, overweight, inactivity  Obesity - ↑demand, ↑adipose tissue  Stress - ↑ cortisol  Nutrition - ↑ salt
  6. 6.  Age  Fall Risk  Metabolic syndrome risk  Activity level
  7. 7.  Blood pressure: 160/90  RR 16  Pulse 74  Fingerstick: 450  Height: 5’2”  Weight: 180 lbs.  Pedal pulses not palpable  Lower extremity edema  Left lower extremity edematous, red, warm  BLE shiny, lack of hair, cool to touch  Stage III wound on LLE ankle
  8. 8. PVD – mostly affects lower extremities - Risk factors: age > 50, HX of heart disease, Type I diabetes, HTN, obesity, physical inactivity, smoking - Symptoms: fragile skin on legs/feet, hair loss on legs, non-healing wounds, gangrene, complaint of “numbness” - Diagnosis: angiogram - Complications: Stroke, MI, amputation
  9. 9.  Most common type of heart disease  Arteries to heart become hardened and narrow  Plaque →↑cholesterol→atherosclerosis→ ↓blood supply→angina or MI  Over time = heart failure
  10. 10. MEDS: Furosemide,Heparin,Captopril,Metoprolol EKG Telemetry Echocardiagram Stress test Ultrasound Angiogram TEDS/SCD’s right leg Doppler LLE
  11. 11.  Furosemide  Nitroglycerin  Heparin Insert drug table here MEDICATION EXPECTED OUTCOME Cardiac glycosides Increase cardiac contractility; decrease heartrate Antihypertensives Decrease blood pressure Vasopressors Increase blood pressure Antiarrhythmics Regulate heart rhythm Nitrates Relieve angina Antilipids Decrease cholesterol levels Diuretics Reduce fluid volume Anticoagulants Decrease potential for clot formation
  12. 12. 4th ICS & 5th ICS
  13. 13. Normal Sinus Rhythm P wave – atrial depolarization Q,R,S complex- ventricular depolarization ST segment-complete depolarization of ventricles T wave- ventricular repolarization
  14. 14. PR interval = 0.12 – 0.20 seconds (or 3 small – 1 large box) QRS complex = 0.06 – 0.12 seconds (or 1.5 – 3 small boxes) QT interval = 0.34-0.43 seconds (or 8.5 – 11 small boxes) Heart rate = # of PQRST complexes that occur in 6 seconds multiplied by 10 Small square = 0.04 seconds Large square = 0.20 seconds Five small squares = a large square Five large squares = 1 second
  15. 15. Leads I, II, III, aVR, aVL & aVF are measurements of the frontal plane V1, V2, V3, V4, V5 & V6 are measurements of the horizontal plane
  16. 16. RA LA HEART RL LL -continuous monitoring  Clouds over grass  Smoke over fire  Chocolate is good for your heart
  17. 17.  EKG  Telemetry  Assist with leg exercises, positioning, SCDs/TEDS  Medication :Anticoagulation prophylaxis, diuretics, I & O  Assessment  Education
  18. 18. TEDS (Thromboembo lic Deterrent Stockings) SCD’s (Sequential Compression Device)
  19. 19. o Test to see how blood moves through arteries and veins o Combines traditional ultrasound with doppler o No preparation needed
  20. 20. http://www.youtube.com/watch?v=yzxSrLa1d0g o Use of radiopaque dye to outline vessels looking for blockage or narrowing
  21. 21. http://www.youtube.com/watch?v=N7nghr9TpSU o Percutaneous Transluminal Coronary Angioplasty o Catheter placed through IV in neck, arm or groin o Balloon tip inflated to compress blockage o Possible stent placement
  22. 22.  Placed with balloon catheter  Locks in open position  Monitor for dysrythmias
  23. 23.  Check peripheral pulses & VS  Assess pain  Assess bleeding or hematoma formation at insertion site  Maintain pressure dressing & immobilize limb for approximately 6 hours  Monitor for urination within 6 hours  Administer fluids  Document
  24. 24. http://www.youtube.com/watch?v=x_Z0GF6AuTw Records cardiovascular response to increased activity
  25. 25. http://www.youtube.com/watch?v=2XR6etAY_-w&feature=related -Ultrasonic waves - Detect structural defects -Can be done at bedside
  26. 26.  DNR – do not rescusitate  DNI – do not intibate  MOLST – Maryland Order for Life Sustaining Treatment
  27. 27. 1. Smoking – most modifiable risk factor for cardiovascular disease 2. Medication 3. Edema 4. Pain management 5. Activity intolerance 6. Diet
  28. 28.  Peripheral intravascular device  Inserted by nurses/techs  Short term
  29. 29. Triple Lumen Central Line  Can be placed at bedside  Placed into internal jugular  Risk of pneumothorax or air embolism  Short term Hickman  Placed on OR  Terminates in superior vena cava near entrance to right atrium  Tunnelling  Long term
  30. 30. Peripherally Inserted Central Catheter  Terminates in subclavian or superior vena cava  Small diameter  Long term
  31. 31. Mediport  Placed in OR  Terminates in superior vena cava near entrance to right atrium  Self sealing port  Long term Huber needle  Non-coring needle used to access mediport
  32. 32. oFirst responder oBedside nurse oCharge nurse oTeam/Code Leader oRecorder oRunner oRespiratory/Anesthesia oCode cart nurse oNursing supervisor oSecurity
  33. 33. Emergency meds Defibrillator Blood drawing supplies Central line kit Backboard
  34. 34.  Laryngoscope  Oropharyngeal airway
  35. 35.  60-100 pbm
  36. 36. Bradycardia - <60 bpm Tachycardia - >100 bpm
  37. 37.  Ectopic foci in walls of ventricles  ↓ cardiac output  Intrinsic ventricular rate is only 20-40 bpm
  38. 38.  Premature ventricular contraction  Irritable focus in ventricle  More likely to occur during bradycardia  A beat, not a rhythm  Cause Bigeminy – PVC’s with every other beat Trigeminy – PVC’s every third beat Quadreminy – PVC’s with every fourth beat
  39. 39. • Foci in ventricles takes over • When 3 or more PVC’s occur in a row at a rate greater than 100 bpm lasting longer than 30 seconds • Treatment: cardioversion & CPR. Long term- antiarrythmic drugs
  40. 40.  Rapid, disorganized depolarization of ventricles  No coordination of ventricular and atrial contractions  No palpable pulse  Treatment: Defibrillation & CPR. Long term: ICD
  41. 41.  Pulseless electrical activity  Electrical activity is present but no contraction  No cardiac output, no tissue perfusion, death
  42. 42.  No electrical activity  Immediate loss of oxygen supply to brain, heart and tissue
  43. 43. Holter monitor o Worn for 1-3 days o Records activity of heart
  44. 44. Pacemaker o Used to augment or replace the natural pacemaker of the heart o Can be used for bradycardia/tahcycardia, damage to heart from MI, CHF
  45. 45. ICD – Implantable Cardiac Defibrillator o To treat ventricular tachycardia and ventricular fibrillation o Patients say a shock is like being kicked in the chest o Another person touching the person will feel the shock

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