The document discusses diagnostic tests, signs and symptoms, and nursing interventions for various cardiac conditions including coronary artery disease, angina, heart failure, myocardial infarction, arrhythmias, and congenital heart diseases. It provides details on lab tests, diagnostic imaging, characteristics of different types of angina, and nursing care for related procedures and lifestyle modifications. Cardiac conditions are examined along with their defining features, complications, and appropriate nursing assessments and treatments.

1. CARE OF CLIENTS WITH
PROBLEMS IN
OXYGENATION
(PART 2)
Mr. Jayesh Patidar

2. DIAGNOSTIC TESTS

3. CK-MB (CREATININE
KINASE, MYOCARDIAL MUSCLE)
 Anelevation in value indicates myocardial
damage
 An elevation occurs within 4 to 6 hours and
peaks 18 to 24 hours following an acute
ischemic attack
 Normal value is 0% to 5% of total; total CK
is 26 to 174 units/L

4. LACTATE DEHYDROGENASE (LDH)
 Elevationsin LDH levels occur 24 hours
following myocardial infarction and peak in
48 to 72 hours
 Normally, LDH1 is lower than LDH2; when
the serum concentration of LDH1 is higher
than LDH2, the pattern is indicated as
“flipped”, signifying myocardial necrosis
 140 to 280 IU/L

5. TROPONIN
 Is composed of troponin C, cardiac troponin
I, and cardiac troponin T
 Has a high affinity for myocardial injury; it
rises within 3 hours and persists for up to 7
days
 Troponin I – lower than 0.6ng/mL
 Troponin T – 0 to 0.2ng/mL

6. COMPLETE BLOOD COUNT
 RBC decreases in rheumatic heart disease
and infective endocarditis and increases in
conditions characterized by inadequate
tissue oxygenation
 The WBC increases in infectious and
inflammatory diseases of the heart and after
MI to dispose necrotic tissue resulting from
infarction

7.  Elevated hematocrit level can result from
vascular volume depletion
 Decreases in hematocrit and hemoglobin
levels can indicate pneumonia

8. SERUM LIPIDS
 The lipid profile measures serum
cholesterol, triglyceride, and lipoprotein
levels
 Isused to assess the risk of developing
coronary artery disease
 Serum cholesterol – lower than 200mg/dL
 LDL – lower than 130mg/dL
 HDL – 30 to 70 mg/dL

9. B-TYPE NATRIURETIC PEPTIDE (BNP)
 Isreleased in response to atrial and
ventricular stretch; it serves as a marker for
congestive heart failure
 Should be lower than 100pg/mL
 Thehigher the level, the more severe the
congestive heart failure

10. ELECTROCARDIOGRAPHY
 Noninvasive test that records the electrical
activity of the heart and is useful for
detecting cardiac dysrhythmias, location and
extent of MI, and cardiac hypertrophy and
for evaluation of the effectiveness of
medications

11. INTERVENTIONS
 Determine the client’s ability to lie still; advise
the client to lie still, breathe normally, and
refrain from talking during the test
 Reassure the client that an electrical shock
will not occur
 Document any cardiac medications the client
is taking

12. ECHOCARDIOGRAPHY
 Noninvasive procedure based on the
principles of ultrasound and evaluates
structural and functional changes in the
heart
 Heart chamber size is measured, ejection
fraction is calculated, and flow gradient
across the valve is determined

13. EXERCISE TESTING (STRESS TEST)
 Noninvasive test that studies the heart
during activity and detects and evaluates
coronary artery disease
 Treadmill
testing is the most commonly
used mode of stress testing

14. INTERVENTIONS
 Obtain an informed consent if required
 Provideadequate rest the night before the
procedure
 Instruct
the client to eat a light meal 1 to 2
hours before the procedure
 Instruct
the client to avoid smoking, alcohol
and caffeine before the procedure

15.  Instructclient to wear nonconstrictive,
comfortable clothing and supportive rubber-
soled shoes for the exercise stress test
 Instruct
the client to notify the physician if
any chest pain, dizziness, or shortness of
breath occurs during the procedure
 Instruct
client to avoid taking a hot bath or
shower for at least 1 to 2 hours after the
procedure

16. DIGITAL SUBTRACTION ANGIOGRAPHY
 This test combines x-ray techniques and a
computerized subtraction technique with
fluoroscopy for visualization of the
cardiovascular system
A contrast media (dye) is injected

17. INTERVENTIONS
 Assess for allergies to seafood, iodine, or
radiopaque dyes. Premedicate client with
antihistamines or corticosteroids to prevent
a reaction
 Obtain informed consent
 Monitor vital signs
 Assess injection site for bleeding or
discomfort

18. MAGNETIC RESONANCE IMAGING
 Noninvasive diagnostic test that produces
an image of the heart or great vessels
through interaction of magnetic fields, radio
waves, and atomic nuclei
 Provides information on chamber size and
thickness, valve and ventricular
function, and blood flow through the great
vessels and coronary arteries

19. INTERVENTIONS
 Evaluate client for the presence of
pacemaker or other implanted items that
present a contraindication to the test
 Ensure client has removed all metallic
objects such as watch, jewelry, clothing with
metal fasteners, and metal hair fasteners
 Informclient that she or he may experience
claustrophobia while in scanner

20. SICKLE CELL ANEMIA

21.  Constitutes a group of diseases termed
hemoglobinopathies, in which hemoglobin A
is partly or completely replaced by abnormal
sickle hemoglobin S
 Caused by inheritance of a gene for a
structurally abnormal portion of the
hemoglobin chain
 Hemoglobin S is sensitive to changes in the
oxygen content of the RBC

22.  Insufficientoxygen causes the cells to
assume a sickle cell shape and the cells
become rigid and clumped
together, obstructing capillary blood flow
 Situations that precipitate sickling include
fever and emotional or physical stress; any
condition that increases the need for oxygen
or alters the transport of oxygen can result in
sickle cell crisis

23.  At risk are those having parents
heterozygous for hemoglobin S or being of
African American descent
 Sicklecell crises are acute exacerbations of
the disease, which vary considerably in
severity and frequency ; these include vaso-
occlusive crisis, splenic sequestration, and
aplastic crisis

24. VASO-OCCLUSIVE CRISIS
 Caused by stasis of blood with lumping of
the cells in the
microcirculation, ischemia, and infarction
 Fever, painful swelling of the
hands, feet, and joints, and abdominal pain

25. SPLENIC SEQUESTRATION
 Caused by the pooling and clumping of
blood in the spleen (hypersplenism).
 Profound anemia, hypovolemia, and shock

26. APLASTIC CRISIS
 Caused by the diminished production and
increased destruction of RBC, triggered by
viral infection or the depletion of folic acid
 Profound anemia and pallor

27. INTERVENTIONS
 Maintainadequate hydration and blood flow
with IV administered NSS and with oral
fluids
 Administer oxygen and blood products as
prescribed
 Administer analgesics as prescribed(ATC)
 Administration of meperidine (Demerol) is
avoided

28.  Assist the child to assume a comfortable
position so that the child keeps the
extremities extended to promote venous
return
 Elevate the bed of the head 30
degrees, avoid putting strain on painful
joints, and do not raise the knee gatch of the
bed
 Encourage consumption of high-calorie, high
protein diet, with folic acid supplementation

29.  Administer antibiotics as prescribed to
prevent infection
 Monitorfor signs of complications, including
increasing anemia, decreased perfusion,
and shock
 Instructthe child and parents about the
early signs and symptoms of crisis and the
measures to prevent crisis

30. IRON DEFICIENCY ANEMIA

31.  Ironstores are depleted, resulting in a
decreased supply of iron for the manufacture
of hemoglobin in RBC
 Commonly results from blood loss, increased
metabolic demands, syndromes of GI
malabsorption and dietary inadequacy

32. SIGNS AND SYMPTOMS
 Pallor
 Weakness and fatigue
 Irritability

33. INTERVENTIONS
 Increase the oral intake of iron
 Instructthe child and parents in food
choices that are high in iron
 Administer iron supplements as prescribed
 Giveiron supplements between meals for
maximum absorption

34.  Give iron supplements with a multivitamin or
fruit juice because vitamin C increases
absorption
 Do not give iron supplements with milk or
antacids because these items decrease
absorption
 Teach the child and parents that a liquid iron
preparation stains the teeth and should be
taken through a straw
 Inform parents/client on side effects
(constipation, black stools, foul aftertaste)

35. HEMOPHILIA

36.  Refers to a group of bleeding disorders
resulting from a deficiency of specific
coagulation proteins
 Factor
VIII deficiency (hemophilia A or classic
hemophilia)
 Factor IX deficiency (hemophilia B or
Christmas disease)
 Result as an X-linked recessive disorder

37.  Most frequently transmitted by the union of
an unaffected male with a trait-carrier
female; however, it can result from the union
between an affected male and a normal or
carrier female

38. SIGNS AND SYMPTOMS
 Abnormal bleeding in response to trauma or
surgery (usually detected after circumcision)
 Epistaxis
 Joint bleeding causing
pain, tenderness, swelling and limited ROM
 Tendency to bruise easily
 Platelet
test is normal; clotting factor function
may be abnormal

39. INTERVENTIONS
 Monitorfor bleeding and maintain bleeding
precautions
 Prepare to administer replacement factors
as prescribed
 Monitor for joint pain; immobilize the
affected extremity if joint pain occurs
 Assess neurological status (child is at risk
for intracranial hemorrhage)

40.  Control joint bleeding by
immobilization, elevation, and the
application of ice; in addition, apply
pressure (15 minutes) for superficial
bleeding
 Instruct parents how to control bleeding
 Instruct the parents on activities to be
avoided by the child, emphasizing
avoidance of contact sports and the need
for protective devices while learning to walk

41.  Instruct
the child to wear protective devices
such as helmets and knees and elbow pads
when participating in sports such as bicycling
and skating

42. KAWASAKI DISEASE

43.  Is known as mucocutaneous lymph node
syndrome and is an acute systemic
inflammatory illness
 The cause is unknown but may be associated
with an infection from an organism or toxin
 Cardiac involvement is the most serious
complication; aneurysms can develop

44. SIGNS AND SYMPTOMS
 Fever
 Conjunctival hyperemia
 Red throat acute stage
 Swollen hands, rash,
and enlargement of the
cervical lymph nodes

45.  Crackling lips
and fissures
 Desquamation of the
skin on the tips of the
fingers and toes
subacute stage
 Joint pain
 Cardiac manifestations
 Thrombocytosis

46.  Convalescent stage
 appears normal but signs of inflammation
may be present

47.  Irritability
may last up for up to 2 months after
the onset of symptoms
 Peeling of the hands and feet may occur
 Pain in the joints may persist for several
weeks
 Stiffnessin the morning, after naps, and in
cold temperatures may occur

48. INTERVENTIONS
 Monitor temperatures frequently (refer if 101F
or higher)
 Assess heart sounds, rate, and rhythm
 Assessextremities for edema, redness, and
desquamation
 Examine eyes for conjunctivitis
 Monitor mucous membranes for inflammation

49.  Monitor strict intake and output
 Administer soft foods and liquids that are
neither too hot nor too cold
 Weigh the child daily
 Provide passive range of motion exercises to
facilitate joint movement
 Administer ASA as prescribed

50.  Administerimmune globulin intravenously as
prescribed to reduce the duration of the fever
and the incidence of coronary artery lesions
and aneurysms

51. CORONARY ARTERY DISEASE

52.  Narrowing or obstruction of one or more
coronary arteries as a result of
atherosclerosis, which is an accumulation of
lipid-containing plaque in the arteries
 Causes decreased perfusion of myocardial
tissue and inadequate myocardial oxygen
supply
 Symptoms occur when the coronary artery is
occluded to the point that inadequate blood
supply to the muscle occurs causing ischemia

53.  Coronary artery narrowing is significant if the
lumen diameter of the left main artery is
reduced at least 50%, or if any major branch
is reduced at least 75%
 The goal of treatment is to alter
atherosclerotic progression
 Cardiac catheterization provides the most
definitive source for diagnosis

54. SIGNS AND SYMPTOMS
 Chest pain
 Palpitations
 Dyspnea
 Syncope
 Cough or hemoptysis
 Excess fatigue

55.  When blood flow is reduced and ischemia
occurs, ST segment depression, T wave
inversion, or both is noted; ST segment
returns to normal when the blood flow
returns
 With infarction, cell injury results in ST
segment elevation, followed by T wave
inversion and an abnormal Q wave
 Blood lipid levels may be elevated

56. INTERVENTIONS
 Instruct
the client regarding the purpose of
diagnostic medical and surgical procedures
and pre procedure and post procedure
expectations
 Assist
the client to identify risk factors that
can be modified
 Assist the client to set goals to promote
lifestyle changes to reduce the impact of risk
factors

57.  Instruct the client regarding a low-
calorie, low sodium, low cholesterol, and low
fat diet with an increase in dietary fiber
 Stressto the client that dietary changes are
maintained for life
 Provide community resources to the client
regarding exercise, smoking cessation, and
stress reduction as prescribed

58. SURGICAL PROCEDURES
 PTCA to compress the plaque against the
walls of the artery and dilate the vessel
 Laser angioplasty to vaporize the plaque
 Atherectomy to remove the plaque from
artery
 Coronary artery bypass grafting to improve
blood flow to the myocardial tissue at risk for
ischemia or infarction

59. ANGINA

60.  Chest pain resulting from myocardial
ischemia caused by inadequate myocardial
blood and oxygen supply
 Caused by an imbalance between oxygen
supply and demand
 Causes include obstruction of coronary
blood flow resulting from atherosclerosis,
coronary artery spasm, or conditions
increasing myocardial oxygen consumption

61. PATTERNS OF ANGINA
 Stable Angina
 Also called exertional angina
 Occurs with activities that involve exertion or
emotional stress; relieved with rest or
nitroglycerin
 Usually has a stable pattern of
onset, duration, severity and relieving factors

62.  Unstable Angina
 Also called preinfarction angina
 Occurs with an unpredictable degree of
exertion or emotion and increases in
occurrence, duration, and severity over time
 Pain may not be relieved with nitroglycerin

63.  Variant Angina
 Also called Prinzmetal’s or vasospastic angina
 Results from coronary artery spasm
 May occur at rest
 Attacks may be associated with ST segment
elevation noted on the ECG

64.  Intractable Angina – is a
chronic, incapacitating angina unresponsive
to interventions
 Preinfarction Angina
 Associated with acute coronary insufficiency
 Lasts longer than 15 minutes
 Symptom of worsening cardiac ischemia
 Occurs after an MI, when residual ischemia may
cause episodes of angina

65. SIGNS AND SYMPTOMS
 Pain
 Dyspnea
 Pallor
 Sweating
 Palpitations and tachycardia

66.  Dizziness and faintness
 Hypertension
 Digestive disturbances

67. INTERVENTIONS
 Assess pain
 Provide bed rest
 Administer oxygen at 3L/min by nasal
cannula as prescribed
 Administer nitroglycerin as prescribed
 Obtain a 12-lead ECG

68.  Provide a continuous cardiac monitoring
 Assist the client in identifying angina-
precipitating events
 Instruct
client to stop activity and rest if
chest pain occurs and to take nitroglycerin
as prescribed
 Instruct
client to seek medical attention if
pain persists

69.  Assist
client to identify risk factors that can
be modified
 Provide dietary instructions
 Provide community resources to the client
regarding exercise, smoking cessation, and
stress reduction

70. MYOCARDIAL INFARCTION

71.  Occurswhen myocardial tissue is abruptly
and severely deprived of oxygen
 Ischemia can lead to necrosis of myocardial
tissue if blood flow is not restored
 Infarctiondoes not occur instantly but
evolves over several hours
 Obvious physical changes do not occur in
the heart until 6 hours after the
infarction, when the infarcted areas appears
blue and swollen

72.  Not all clients experience the classic
symptoms of an MI
 Women may experience atypical discomfort
, shortness of breath, or fatigue
 Anolder client may experience shortness of
breath, pulmonary
edema, dizziness, altered mental status, or
a dysrhythmia

73. SIGNS AND SYMPTOMS
 Pain
 Nausea and vomiting
 Diaphoresis
 Dyspnea
 Dysrhythmias

74.  Feelings of fear and anxiety
 Pallor
 Cyanosis
 Coolness of extremities

75. INTERVENTIONS
 Obtain a description of the chest discomfort
 Assess vital signs
 Assess cardiovascular status
 Place client in a semi-Fowler’s position
 Administeroxygen at 2 to 4L/min by nasal
cannula as prescribed

76.  Establish an IV access route
 Administer nitroglycerin as prescribed
 Administer morphine sulphate as prescribed
to relieve chest discomfort
 Obtain a 12-lead ECG
 Monitor thrombolytic therapy, which may be
prescribed for the first 6 hours of the coronary
event

77.  Administer beta blockers as prescribed
 Assess distal peripheral pulses and skin
temperature
 Monitor intake and output
 Assess RR and breath sounds for signs of heart
failure
 Monitor BP closely
 Provide reassurance to the client and family

78.  Maintainbed rest for the first 24 to 36 hours
as prescribed
 Allowthe client to stand to void or use a bed
side commode if prescribed
 Provide ROM exercises
 Encourage client to verbalize feeling
regarding the MI

79. RAYNAUD’S DISEASE

80.  Vasospasms of the arterioles and arteries of
the upper and lower extremities
 Vasospasms cause constriction of the
cutaneous vessels
 Attacksare intermittent and occur with
exposure to cold or stress
 Affects primarily fingers, toes, ears, and
cheeks

81. SIGNS AND SYMPTOMS
 Blanching of the extremity, followed by
cyanosis during constriction
 Reddened tissue when the vasospasm is
relieved
 Numbness, tingling, swelling, and a cold
temperature at the affected body part

82. INTERVENTIONS
 Monitor pulses
 Administer vasodilators as prescribed
 Assist the client to identify and avoid
precipitating factors such as cold and stress
 Instruct the client to avoid smoking

83.  Instruct
the client to wear warm clothing,
socks and gloves in cold weather
 Advise client to avoid injuries to fingers and
hands

84. BUERGER’S DISEASE

85.  Thromboangiitis obliterans
 An occlusive disease of the median and small
arteries and veins
 Thedistal upper and lower limbs are affected
most commonly

86. SIGNS AND SYMPTOMS
 Intermittent claudication
 Ischemic pain occurring in the digits while at
rest
 Aching pain that is more severe at night
 Cool, numb, or tingling sensation
 Diminished distal pulses

87.  Extremities
that are cool and red in the
dependent position
 Development of ulcerations in the
extremities

88. INTERVENTIONS
 Instruct the client to stop smoking
 Monitor pulses
 Instruct
the client to avoid injury to the upper
and lower extremities
 Administer vasodilators as prescribed