Cardiac Assessment and Diagnostics Review

Cardiac Content Review

• Head to Toe Cardiac Clues: Assess for brittle/dry hair (possible poor nutrition), vascular changes in eyes, cyanosis or dehydration in lips/tongue, distended jugular veins (hypervolemia, right-sided heart failure), lung crackles (left-sided heart failure), murmurs, fluid accumulation (ascites), enlarged liver (right-sided heart failure), dry/cool skin (poor nutrition), clubbed nails (chronic low O2 saturation), thin skin and lack of hair (poor circulation), edema, and presence of pulses and sensation in lower extremities.

Diagnostics for Chest Pain

• Electrolytes, lipids, troponin, CK-MB, EKG, exercise stress test, Holter monitor: Used to diagnose potential cardiac issues.
• Cardiac catheterization (cardiac cath): Post-procedure monitoring for bleeding and vital sign assessment, checking pulses distal to insertion site.

Rhythms and Treatments

• Sinus Bradycardia: Give O2, stimulate patient, administer atropine, or pacemaker. Assess for signs of distress and address underlying causes.
• Atrial Fibrillation (Afib): Administer warfarin, diltiazem. Monitor PT/INR (2-3 if therapeutic). Consider cardioversion.
• Other Rhythms: First check for pulse; if no pulse, defibrillation may be necessary.

Left-Sided Heart Failure (LHF)

• Blood Back-up: Blood backs up into the lungs from the left atrium causing respiratory symptoms (dyspnea, confusion, crackles, orthopnea, cyanosis, fatigue, weak pulses).

Right-Sided Heart Failure (RHF)

• Blood Back-up: Blood backs up into the body from the superior/inferior vena cava causing symptoms of edema in hands/feet, abdominal distention, ascites, JVD, enlarged liver and spleen.

Heart Failure Treatment

• General Treatment: Daily weights, low sodium diet, oxygen, furosemide and valsartan for heart failure; monitor for dehydration, hypokalemia (lethargy, decreased GI motility, heart irregularities). Take meds in the morning.
• Additional Considerations: Report dizziness, lightheadedness, cough, and monitor electrolytes and renal function.

Hypertension Evaluation and Management

• Initial Readings: Patient's blood pressure readings (182/88, 178/86, 180/82). Diagnosis of hypertension.
• Management: Teach patient DASH diet, weight loss, alcohol limitation, exercises, and stop smoking. Relaxation techniques for stress. Monitor for side effects of medication (orthostatic hypotension and electrolyte imbalances) and home blood pressure monitoring.

Atherosclerosis

• Possible Symptoms: High total cholesterol (300), LDL (220) while HDL is low (80). Symptoms include hypertension, chest pain, decreased or absent pulses in extremities, and cool extremities.
• Possible Underlying Causes: Sedentary lifestyle, smoking, diabetes, and high-fat diets are possible underlying causes for increased cholesterol.
• Treatment: Statins (for lowering cholesterol). Watch for side effects like abdominal pain, constipation, muscle cramping, and diarrhea.

Peripheral Vascular Disease (PVD)

• Symptoms: No hair growth, intermittent claudication, rubor (redness), ulcers.
• Treatment: Stent placement to increase blood flow, compression stockings, exercise, and weight loss.

Buerger's Disease

• Symptoms: Ischemia to feet, linked to smoking, intermittent claudication, sensitive to cold temps, ulcers. Avoid cold temperatures, stop smoking, and take medications as prescribed.

Raynaud's Disease

• Symptoms: Vasospasms of hands, painful when exposed to cold. Same treatment as Buerger's disease.

Deep Vein Thrombosis (DVT)

• Symptoms: Symptoms in hip replacement patient (hot, swollen, red, hard calf).
• Treatment: Heparin IV in the hospital.

Monitoring and Teaching

• Bleeding Time: Monitor activated partial thromboplastin time (aPTT) while patient is on heparin (60-80 seconds). Discuss bleeding risks.
• Patient Education: Teach patients about foot care (aches, heaviness, varicose veins), high-impact exercise avoidance, compression stockings, weight loss, and elevation techniques.
• Medication adherence: Encourage medication adherence and emphasize monitoring for side-effects.

Myocardial Infarction (MI)

• Symptoms: Chest pain, indigestion, weakness, shortness of breath (SOA). Use MONA medication (Morphine, Oxygen, Nitroglycerin, and Aspirin).