Cardiac/Vascular Circulation <ul><li>Brenda Rowe, RN, MN, JD </li></ul><ul><li>Georgia Baptist College of Nursing  </li></...
C.O. = Stroke Vol. X Heart Rate <ul><li>Preload - passive stretching force exerted on ventricle muscle </li></ul><ul><li>C...
Cardiac Effects of Digoxin <ul><li>Positive inotropin effect: strengthens the force of contraction </li></ul><ul><li>Negat...
Digoxin *  CHF, atrial fib * digitalization * toxic effects - N&V, diarrhea, green/yellow vision, double vision, headache,...
Nursing Interventions <ul><li>Monitor HR - apical for 1 minute </li></ul><ul><li>Monitor Dig level - 0.5-2.0 ng/ml </li></...
Other Cardiac Glycosides <ul><li>inamrinone (Inocor) & milrinone (Primacor): increase force of contraction and produce a v...
Critical Thinking Exercise <ul><li>A patient with CHF </li></ul><ul><li>Is on Digoxin, Lasix, and potassium supplement </l...
Nitroglycerin <ul><li>Relaxes vascular smooth muscles & dilates arterial & venous vessels thus reducing afterload & myocar...
Tolerance & Adverse Effects <ul><li>Tolerance may develop </li></ul><ul><li>Less likely in sublingual & translingual spray...
Anginal Episode <ul><li>Have a person lie down </li></ul><ul><li>Give nitroglycerin tabs x 3, if needed, 5 minutes apart <...
Education <ul><li>Smoking causes vasoconstriction which may cause angina </li></ul><ul><li>Sublingual: keep in original bo...
Education (cont.) <ul><li>Increase absorption with broken skin, increase with exercise, increase temperature (avoid sauna)...
Antiarrhythmics *  see after MI, cardiac surgery, CAD, electrolyte imbalance, thyroid disease *  abnormality with initiati...
Antiarrhythmic Agents Quinidine (Cardioquin)  – class 1A depresses Phase 0 in depolarization * depresses cardiac function,...
Lidocaine <ul><li>Lidocaine (Xylocaine)  - Class 1B depresses phase 0 but not as much as Quinidine </li></ul><ul><li>brief...
Antiarrhythmic Agents (cont.) Flecainide (Tambocor)  - Class 1C markedly depresses phase 0, tx PAF or flutter & ventricula...
amiodarone (Cordarone) <ul><li>Amiodarone (Cordarone)  - Class III prolongs phase III repolarization </li></ul><ul><li>inc...
Verapamil HCL (Calan) <ul><li>Class IV depresses phase 4 depolarization & lengthens phase 1 & 2 of repolarization </li></u...
Potassium-Removing Resins <ul><li>Sodium polystyrene sulfonate (Kayexalate) </li></ul><ul><li>oral or enema </li></ul><ul>...
Antihyperlipidemics <ul><li>Definition </li></ul><ul><li>HDL/LDL </li></ul>
Statins <ul><li>lovastatin (Mevacor) </li></ul><ul><li>Blocks synthesis of cholesterol in liver </li></ul><ul><li>Decrease...
Bile acid sequestrants <ul><li>cholestyramine (Questran) </li></ul><ul><li>Lower LDL levels </li></ul><ul><li>Binds bile a...
New drugs <ul><li>How actions differ </li></ul>
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Cardiac PowerPoint

  1. 1. Cardiac/Vascular Circulation <ul><li>Brenda Rowe, RN, MN, JD </li></ul><ul><li>Georgia Baptist College of Nursing </li></ul><ul><li>of Mercer University </li></ul>
  2. 2. C.O. = Stroke Vol. X Heart Rate <ul><li>Preload - passive stretching force exerted on ventricle muscle </li></ul><ul><li>Contractility - force of the squeezing that the ventricle is able to achieve </li></ul><ul><li>Afterload - amount of pressure the ventricle muscle must overcome to eject </li></ul><ul><li>Contraction - dependent upon conduction system </li></ul>
  3. 3. Cardiac Effects of Digoxin <ul><li>Positive inotropin effect: strengthens the force of contraction </li></ul><ul><li>Negative dromotropin effect: decreases conduction </li></ul><ul><li>Negative chronotropin effect: decreases heart rate </li></ul><ul><li>Improve renal perfusion </li></ul>
  4. 4. 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
  5. 5. Nursing Interventions <ul><li>Monitor HR - apical for 1 minute </li></ul><ul><li>Monitor Dig level - 0.5-2.0 ng/ml </li></ul><ul><li>Monitor K, Calcium, Mag - increase in calcium or decrease in K or Mag will potentiate the effect of Digoxin </li></ul>
  6. 6. Other Cardiac Glycosides <ul><li>inamrinone (Inocor) & milrinone (Primacor): increase force of contraction and produce a vasodilatory effect which increases cardiac output </li></ul><ul><li>Used for short term management of CHF </li></ul>
  7. 7. Critical Thinking Exercise <ul><li>A patient with CHF </li></ul><ul><li>Is on Digoxin, Lasix, and potassium supplement </li></ul><ul><li>What is the desired therapeutic effect? </li></ul><ul><li>Why should hypokalemia be prevented? </li></ul><ul><li>What blood work should be monitored? </li></ul>
  8. 8. Nitroglycerin <ul><li>Relaxes vascular smooth muscles & dilates arterial & venous vessels thus reducing afterload & myocardial consumption </li></ul><ul><li>Acute angina: sublingual, transmucosal, or translingual spray </li></ul><ul><li>Prophylactic for angina: above & topical & oral SR </li></ul><ul><li>IV: used to treat primarily hypertension </li></ul>
  9. 9. Tolerance & Adverse Effects <ul><li>Tolerance may develop </li></ul><ul><li>Less likely in sublingual & translingual spray </li></ul><ul><li>Most common adverse effects: headache, can have hypotension, tachycardia, syncope </li></ul>
  10. 10. Anginal Episode <ul><li>Have a person lie down </li></ul><ul><li>Give nitroglycerin tabs x 3, if needed, 5 minutes apart </li></ul><ul><li>If no relief – call 911 </li></ul>
  11. 11. Education <ul><li>Smoking causes vasoconstriction which may cause angina </li></ul><ul><li>Sublingual: keep in original bottle with tight cap </li></ul><ul><li>Transdermal: nonhairy area but avoid distal parts of extremities, remove patch for 10-12 hours </li></ul>
  12. 12. Education (cont.) <ul><li>Increase absorption with broken skin, increase with exercise, increase temperature (avoid sauna) </li></ul><ul><li>Ointment: choose a different application site, use tissue to remove any old ointment, do not massage or rub in ointment </li></ul>
  13. 13. 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)
  14. 14. 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
  15. 15. Lidocaine <ul><li>Lidocaine (Xylocaine) - Class 1B depresses phase 0 but not as much as Quinidine </li></ul><ul><li>brief action so less chance of cumulative drug toxicity, make sure you have correct type of Lidocaine, tx ventricular arrhythmias </li></ul><ul><li>give IV </li></ul>
  16. 16. 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
  17. 17. amiodarone (Cordarone) <ul><li>Amiodarone (Cordarone) - Class III prolongs phase III repolarization </li></ul><ul><li>increases refractory period, increases myocardial contractility, vasodilatory action </li></ul><ul><li>used to prophylaxis and therapy of vent fib </li></ul><ul><li>keep pt supine - most common AE is orthostatic hypotension </li></ul>
  18. 18. Verapamil HCL (Calan) <ul><li>Class IV depresses phase 4 depolarization & lengthens phase 1 & 2 of repolarization </li></ul><ul><li>calcium channel blocker, decrease myocardial contraction, decrease SA node impulse, decrease conduction, also causes CA dilatation & peripheral vasodilatation </li></ul><ul><li>also used to tx angina </li></ul><ul><li>watch for bradycardia & hypotension </li></ul><ul><li>AE - most common is constipation </li></ul><ul><li>IV solution must be protected from light </li></ul><ul><li>Administer slowly – greater than 2 minutes </li></ul>
  19. 19. Potassium-Removing Resins <ul><li>Sodium polystyrene sulfonate (Kayexalate) </li></ul><ul><li>oral or enema </li></ul><ul><li>AE - hypokalemia </li></ul>
  20. 20. Antihyperlipidemics <ul><li>Definition </li></ul><ul><li>HDL/LDL </li></ul>
  21. 21. Statins <ul><li>lovastatin (Mevacor) </li></ul><ul><li>Blocks synthesis of cholesterol in liver </li></ul><ul><li>Decrease LDL, increase HDL </li></ul>
  22. 22. Bile acid sequestrants <ul><li>cholestyramine (Questran) </li></ul><ul><li>Lower LDL levels </li></ul><ul><li>Binds bile acids in intestine </li></ul>
  23. 23. New drugs <ul><li>How actions differ </li></ul>

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