Podcast
Questions and Answers
What does an elevated jugular venous distension (JVD) indicate in a patient?
What does an elevated jugular venous distension (JVD) indicate in a patient?
Which symptom is NOT typically associated with low cardiac output?
Which symptom is NOT typically associated with low cardiac output?
What are the 6 P's indicating acute obstruction of arterial blood flow?
What are the 6 P's indicating acute obstruction of arterial blood flow?
In response to low cardiac output, which compensatory mechanism is likely to occur first?
In response to low cardiac output, which compensatory mechanism is likely to occur first?
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What does a postural change indicating a drop in blood pressure when standing suggest?
What does a postural change indicating a drop in blood pressure when standing suggest?
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Which sign indicates inadequate brain perfusion due to compromised cardiac output?
Which sign indicates inadequate brain perfusion due to compromised cardiac output?
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What type of lung sounds would indicate fluid buildup in a patient?
What type of lung sounds would indicate fluid buildup in a patient?
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Peripheral edema in a patient is most commonly associated with which condition?
Peripheral edema in a patient is most commonly associated with which condition?
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What is the correct score for pitting edema if the indentation measures 3 mm?
What is the correct score for pitting edema if the indentation measures 3 mm?
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Which of the following is NOT one of the 'Six P's' associated with acute arterial occlusion?
Which of the following is NOT one of the 'Six P's' associated with acute arterial occlusion?
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Which symptom indicates a potential severe ischemic injury in an affected limb?
Which symptom indicates a potential severe ischemic injury in an affected limb?
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What causes the limb to feel colder in the case of poikilothermia?
What causes the limb to feel colder in the case of poikilothermia?
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Which condition is most likely associated with xanthelasma?
Which condition is most likely associated with xanthelasma?
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The absence of a detectable pulse in an affected area is indicative of which condition?
The absence of a detectable pulse in an affected area is indicative of which condition?
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In an acute arterial occlusion, tingling or numbness in the limb is described as which symptom?
In an acute arterial occlusion, tingling or numbness in the limb is described as which symptom?
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What is the primary urgent need when a patient is diagnosed with acute arterial occlusion?
What is the primary urgent need when a patient is diagnosed with acute arterial occlusion?
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Which characteristic skin color change indicates low oxygen levels in the blood?
Which characteristic skin color change indicates low oxygen levels in the blood?
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What does severe and sudden pain in a limb suggest when assessing for acute arterial occlusion?
What does severe and sudden pain in a limb suggest when assessing for acute arterial occlusion?
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What is the primary function of a pacemaker?
What is the primary function of a pacemaker?
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In which condition is a pacemaker primarily indicated?
In which condition is a pacemaker primarily indicated?
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What is the maximum recommended door-to-balloon time for performing PCI in patients?
What is the maximum recommended door-to-balloon time for performing PCI in patients?
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Which of the following is a critical nursing consideration during the administration of thrombolytic therapy?
Which of the following is a critical nursing consideration during the administration of thrombolytic therapy?
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What does the pulse generator in a pacemaker contain?
What does the pulse generator in a pacemaker contain?
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What is the role of leads in a pacemaker?
What is the role of leads in a pacemaker?
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Why should thrombolytics not be used in patients with a recent hemorrhagic stroke?
Why should thrombolytics not be used in patients with a recent hemorrhagic stroke?
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What type of device is an Implantable Cardioverter Defibrillator (ICD)?
What type of device is an Implantable Cardioverter Defibrillator (ICD)?
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What is a major focus of Phase I cardiac rehabilitation?
What is a major focus of Phase I cardiac rehabilitation?
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Which of the following drugs is NOT used in thrombolytic therapy?
Which of the following drugs is NOT used in thrombolytic therapy?
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What complication should be monitored after the insertion of a cardiac device?
What complication should be monitored after the insertion of a cardiac device?
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What is a potential risk associated with the use of thrombolytics in patients?
What is a potential risk associated with the use of thrombolytics in patients?
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Who may be at high risk for needing an ICD?
Who may be at high risk for needing an ICD?
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What should patients avoid after receiving a pacemaker or ICD?
What should patients avoid after receiving a pacemaker or ICD?
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How long does Phase II of cardiac rehabilitation typically last?
How long does Phase II of cardiac rehabilitation typically last?
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What is the primary purpose of electrophysiology (EP) studies?
What is the primary purpose of electrophysiology (EP) studies?
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What is a common sign of possible infection at the incision site after device insertion?
What is a common sign of possible infection at the incision site after device insertion?
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What is the primary goal when treating a patient experiencing angina?
What is the primary goal when treating a patient experiencing angina?
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Which of the following is NOT considered a part of Acute Coronary Syndrome (ACS)?
Which of the following is NOT considered a part of Acute Coronary Syndrome (ACS)?
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Which intervention is crucial for reducing patient anxiety related to cardiac symptoms?
Which intervention is crucial for reducing patient anxiety related to cardiac symptoms?
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What initial assessment should be performed after administering nitroglycerin to a patient?
What initial assessment should be performed after administering nitroglycerin to a patient?
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What is an appropriate action to promote home care for a patient with a cardiac condition?
What is an appropriate action to promote home care for a patient with a cardiac condition?
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Which of the following symptoms is most commonly associated with Acute Coronary Syndrome?
Which of the following symptoms is most commonly associated with Acute Coronary Syndrome?
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In the context of noncompliance, which factor most significantly contributes to ineffective management of a therapeutic regimen?
In the context of noncompliance, which factor most significantly contributes to ineffective management of a therapeutic regimen?
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What distinguishes STEMI from NSTEMI in an emergency setting?
What distinguishes STEMI from NSTEMI in an emergency setting?
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Which clinical manifestation can accompany the chest pain in a patient with ACS?
Which clinical manifestation can accompany the chest pain in a patient with ACS?
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What is the recommended flow rate for oxygen administration in a patient with suspected cardiac distress?
What is the recommended flow rate for oxygen administration in a patient with suspected cardiac distress?
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Study Notes
Management of Patients with Cardiovascular Diseases
- The objectives of the lecture are to explain the management of patients with dysrhythmias and conduction problems, compare the management of patients with structural, infectious, and inflammatory cardiac disorders, describe the management of patients with complications from heart disease, analyze the management of patients with vascular disorders and problems of peripheral circulation, and describe the assessment and management of patients with hypertension.
Circulation through the Heart
- The image displays a detailed illustration of the heart, including the superior vena cava, aorta, pulmonary artery, pulmonary vein, mitral valve, pulmonary valve, tricuspid valve, and aortic valve, showing the circulation through the heart.
- The cardiac conduction system, including the SA node, AV node, AV bundle, and Purkinje fibers, is illustrated.
Assessment of the Cardiovascular System
- Health history assessment involves recognizing cardiac symptoms and knowing what to do when they occur for effective self-care and management.
- Common symptoms include chest pain (angina pectoris, ACS, dysrhythmias, valvular heart disease), pain or discomfort in other areas of the upper body, shortness of breath (ACS, cardiogenic shock, HF, valvular heart disease), peripheral edema, weight gain, abdominal distention, palpitations, vital exhaustion, dizziness, and syncope.
Chest Pain
- Chest pain is a common symptom caused by a number of cardiac and non-cardiac problems.
- During the assessment, the patient should identify the quantity of pain using a pain scale, describe the character or quality of the pain and its location, and note if there is radiation to other areas, associated signs and symptoms, factors that precipitate symptoms, and what measures aggravate or relieve them.
Elimination
- Nocturia (awakening at night to urinate) is common in patients with heart failure (HF). Fluid in gravity-dependent tissues (extremities) redistribute into the circulatory system at night causing increased urine production.
- When straining during defecation, the Valsalva maneuver increases pressure on baroreceptors, causing the heart rate to slow and resulting in syncope in some patients.
Activity and Exercise
- Assessing activity pattern changes over the past 6-12 months, including fatigue related to low left ventricular ejection fraction and medications (beta-adrenergic blocking agents), can determine activity tolerance.
- Orthopnea, short of breath when lying down, relieved by standing or sitting up, describes respiratory difficulties.
- PND(paroxysmal nocturnal dyspnea): sudden awakening gasping for air.
- Nocturnal angina: chest pain due to reduced oxygen supply at night.
- Overall, these indicate worsening heart failure, obstructive sleep apnea linked to CAD, hypertension, HF, and dysrhythmias.
Physical Assessment
- The heart as a pump: Reduced pulse pressure, deviation of PMI (point of maximal impulse) from the fifth intercostal space midclavicular line, gallop sounds, and murmurs.
- Atrial and ventricular filling volumes and pressures: Elevated jugular venous distention, peripheral edema, ascites, crackles, postural changes in blood pressure.
- Cardiac output: Reduced pulse pressure, hypotension, tachycardia, reduced urine output, lethargy, or disorientation.
- Compensatory mechanisms: peripheral vasoconstriction, tachycardia.
General Appearance
- Changes in level of consciousness (inadequate brain perfusion from a compromised cardiac output or thromboembolic event), signs of distress (pain, discomfort, shortness of breath, anxiety), and patient size (normal, overweight, underweight, cachectic).
- Signs of acute obstruction or arterial blood flow in the extremities, also know as the 6 Ps (pain, pallor, pulselessness, paresthesia, poikilothermia, and paralysis). Peripheral edema and pitting, slight to very marked indentation on the skin.
Inspection of the Skin
- Pallor and cyanosis: Pale skin may indicate reduced blood flow or anemia; bluish discoloration due to low oxygen levels in blood, related to heart or lung conditions.
- Xanthelasma: Yellowish, raised plaques on the skin, often around the eyes, suggesting high cholesterol levels.
- Ecchymosis: Bruising or discoloration of skin common in patients on anticoagulants, due to increased bleeding risk.
- Cool/cold and moist skin: Indicates cardiogenic shock, reduced cardiac output and perfusion in the body.
Blood Pressure
- Pulse pressure is the difference between systolic and diastolic blood pressure, normally 30-40 mm Hg.
- Increased pulse pressure: in conditions that elevate stroke volume (anxiety, exercise, bradycardia) or reduce distensibility of the arteries (atherosclerosis, aging, hypertension).
- Decreased pulse pressure: reflects reduced stroke volume (shock, HF, hypovolemia).
- Postural (orthostatic) hypotension: reduction in systolic or diastolic blood pressure within 3 minutes of moving to a standing position.
Arterial Pulses
- Pulse rate, rhythm, and quality (0: not palpable, absent; 1: weak, thready pulse; difficulty to palpate, obliterated with pressure; 2: diminished pulse; cannot be obliterated; 3: full pulse, easy to palpate; 4: strong, bounding pulse. May be abnormal).
- Temporal and carotid pulses should not be palpated simultaneously, as this may reduce blood flow to the brain.
Jugular Venous Pulsations
- Right-sided heart function is estimated by observing the jugular vein pulsations in the neck.
Heart Inspection and Palpation
- Aortic and pulmonic areas for auscultation.
- Erb's point, tricuspid and mitral areas, epigastric area.
Heart Auscultation
- Normal heart sounds (S1 and S2) are produced by the closure of AV valves (tricuspid, mitral) and semilunar valves (pulmonic, aortic), respectively (S1 is lub, S2 is dub)..
- Abnormal Heart Sounds (S3 and S4) result from the rapid ventricular filling (S3: DUB) and atrial contraction (S4: LUB) in noncompliant ventricles.
- Opening snaps occur at the opening of AV valves in the diastolic period.
Diagnostic Evaluation
- Telemetry ECG Continuous monitoring of patient's ECG.
- Ambulatory Electrocardiography (ECG home monitoring). The Holter monitor is used to detect dysrhythmias that may occur during waking hours or sleep.
- Exercise Stress Testing(walking on a treadmill). Monitoring of heart rate, rhythm, blood pressure, skin temperature during this test helps to determine the exercise capacity.
Cardiac Implantable Electronic Devices
- Pacemakers and ICDs (cardiac implantable electronic devices) to manage serious cardiac diseases to monitor battery life, pacing parameters and determine therapies for atrial and ventricular dysrhythmias.
- ECG recordings constantly for 3 years
- Nurses needs dealing with excessive alarms develop alarm fatigue.
- ECG recordings with no artifacts.
- Proper skin preparation while applying electrodes as well as regularly changing the electrodes to reduce artifacts.
Diagnostic Evaluation
- Exercise stress testing: The patient walks on a treadmill to increase heart rate according to established protocols. Multiple ECG leads, blood pressure, and physical appearance are monitored frequently to establish heart rate, rhythm and any ischemic changes.
- Nursing interventions: The patient should not eat or drink anything 3 hours before the test, avoid tobacco and caffeine. Beta-adrenergic blocking agents should be withheld before the test. The patient needs to wear comfortable clothes and sneakers and an IV catheter is inserted to monitor the patient continuously for 10-15 minutes after the test.
Echocardiography - Traditional Echocardiography-noninvasive
- An ultrasound testing that measures ejection fraction, shape, and motion of cardiac structures, painless.
- Periodically the patient is asked to turn onto their left side or hold a breath.
- Radionuclide imaging, Computed Tomography. Magnetic Resonance Angiography
Cardiac Catheterization
- A common invasive procedure for diagnosing structural and functional diseases of the heart and great vessels.
- Fluoroscopy guides catheter advancement through the right and left heart to diagnose and assess conditions.
Management of patients with dysrhythmias
- Dysrhythmias are disorders of impulse formation or/and conduction within the heart, causing disturbances in heart rate, rhythm, or both.
- Normal sinus rhythm involves the impulses originating from the sinoatrial (SA) node with specific PQRST intervals present in the ECG.
Components of the Electrocardiogram
- P, QRS, and ECG intervals including P-R, PR, Q-T and T-P
- Shows waves (P, QRS, T) and segments (PR, ST, QT).
Clinical Manifestations
- Clinical manifestations vary with each type of arrhythmia. Symptoms to assess are chest pain, shortness of breath, dizziness, low blood pressure due to decreased cardiac output, and altered level of consciousness, among others.
- Diagnostic findings include history and physical examinations to identify the onset, nature, frequency, duration, and response to medication. A 12-lead ECG is used to verify the atrial fibrillation rhythm and identify dysrhythmias. Transthoracic echocardiogram (TEE) identifies valvular heart disease, left ventricular and right ventricular size and function.
Adjunctive Modalities and Management
- Cardioversion and Defibrillation: Used to treat rapid heart rhythms, through the delivery of electrical current to depolarize a critical mass of myocardial cells. Timing is important to differentiate between cardioversion and defibrillation.
- Cardioversion restores regular heart rhythm, while defibrillation is used in life-threatening situations.
Pacemaker Therapy
- An electronic device that provides electrical stimuli to the heart muscle to regulate heartbeat when a patient has a permanent or temporary Slower-than-normal impulse formation, or a symptomatic AV disturbance.
- Pacemakers are used to treat disorders like bradycardia (slow heartbeat) and AV blocks (delays or blocks in electrical signals between the heart's upper and lower chambers).
Implantable Cardioverter Defibrillator (ICD)
- Detects and terminates life-threatening episodes of tachycardia or fibrillation, primarily those that are ventricular in origin.
- Used for patients at high risk of sudden cardiac death or who have survived sudden cardiac arrest syndrome (SCD).
- Electrophysiology (EP) studies are invasive procedures to evaluate and treat various chronic arrhythmias that have caused cardiac arrest or significant symptoms.
Nursing Management of the Patient with an Implantable Cardiac Device
- Post-insertion care for patients with implanted pacemakers or ICDs include monitoring the incision site for signs of complications, promoting a safe patient environment, strict adherence to activity restrictions, instructing patients on necessary precautions with electrical and magnetic field exposure.
Nursing Diagnoses
- Decreased cardiac output related to inadequate ventricular filling, anxiety related to fear of the unknown outcome of altered health state, and deficient knowledge about the dysrhythmia and its treatment.
- Nursing interventions include assessing blood pressure, heart rate, respiration rate, breath sounds. Monitoring for symptoms such as lightheadedness, dizziness, and fainting. Encouraging the patient to verbalize their fear and expressing supportive empathy.
Coronary Artery Disease
- Coronary artery disease is a narrowing or blockage of the coronary arteries reducing blood flow to the myocardium.
- Risk factors include family history, increasing age, gender, race, hyperlipidemia, smoking, hypertension, diabetes, metabolic syndrome, obesity, and physical inactivity.
- Clinical manifestations include chest pain (angina), atypical symptoms such as weakness, dyspnea, nausea, and shortness of breath, pain in jaw, shoulders, neck and upper arms.
- Diagnostic findings include history, physical examination (including pain assessment), 12-lead ECG, laboratory studies, and cardiac catheterization.
Coronary Atherosclerosis
- This is the abnormal accumulation of lipid deposits and fibrous tissue in arterial walls and lumen, causing blockages and narrowing of the coronary arteries, reducing blood flow to the myocardium.
Risk Factors for Coronary Artery Disease
- Nonmodifiable: Family history, age, gender (men develop it earlier), race (higher incidence in African Americans).
- Modifiable: Hyperlipidemia, smoking, hypertension, diabetes mellitus, metabolic syndrome, obesity, and physical inactivity.
Clinical Manifestations of Coronary Artery Disease
- A common symptom is chest pain, but some individuals may experience atypical symptoms such as weakness, dyspnea, and nausea; symptoms are more common in women and in persons with a history of heart failure or diabetes.
- Symptoms may include chest pain behind the sternum, radiating to the neck, jaw, shoulders, and upper arms.
Prevention of Cholesterol Abnormalities
- A fasting lipid profile shows LDL cholesterol less than 100 mg/dL (less than 70mg/dL for high risk patients) for very high risk patients, total cholesterol less than 200 mg/dL, HDL cholesterol greater than 40mg/dL for males and 50mg/dL for females, and a triglyceride level less than 150 mg/dL.
- Diet modifications such as low in saturated fats and high in soluble fibers, physical activities, and medication (statins) are recommended.
- Cessation of tobacco use and managing hypertension and diabetes are also needed to stop the progression of these conditions.
Angina Pectoris
- A syndrome characterized by episodes of chest pain or pressure caused by insufficient coronary blood flow.
- Risk factors include physical exertion, exposure to cold temperatures, eating a heavy meal, and stressful situations, which increase myocardial oxygen demand and may lead to insufficient blood flow.
- Symptoms may include chest pain, pressure in the chest region, radiating to the arms, shoulders etc. This pain can be alleviated by rest or medication.
Types of Angina
- Stable angina: Predictable chest pain that occurs with exertion and is relieved by rest and/or nitroglycerin.
- Unstable angina (preinfarction/crescendo angina): Chest pain that increases in frequency and severity and may not be relieved with rest or nitroglycerin.
- Intractable/refractory angina: Severe, incapacitating chest pain, even after medications.
- Variant angina (Prinzmetal's angina): Pain at rest with reversible ST-segment elevation, caused by coronary artery spasm.
- Silent ischemia: Objective evidence of ischemia (changes in ECG with stress test), but the patient reports no pain.
Clinical Manifestations
- Ischemia of the heart muscle may cause mild to severe pain and discomfort, accompanied by a sense of impending death.
- Pain often localizes deep in the chest, behind the sternum, radiating to the neck, jaw, shoulders, and inner upper arms.
- Patients with diabetes may not experience severe pain due to diabetic neuropathy.
- Symptoms may include weakness, dizziness, lightheadedness, shortness of breath, pallor, diaphoresis, nausea, and vomiting.
- Unstable angina attacks increase in frequency and severity and are not relieved by rest or nitroglycerin; requiring urgent medical intervention.
Assessment and Diagnostic Findings
- Patient's history related to clinical manifestations of ischemia, including a 12-lead ECG (t-wave inversion, ST-segment elevation, abnormal Q wave).
- Lab studies to rule out acute coronary syndrome (CRP, cardiac biomarkers). Exercise or pharmacologic stress tests, cardiac catheterization, coronary angiography.
Medical Management:
- Goal: Decrease myocardial oxygen demand and increase oxygen supply..
- Pharmacologic therapy options include: Nitrates (e.g., nitroglycerin), Beta-blockers (e.g., metoprolol), Calcium Channel Blockers (e.g., amlodipine), Antiplatelet medications (e.g., aspirin), Anticoagulants (e.g., heparin).
- Oxygen administration to increase oxygen delivery and decrease pain. Reducing and controlling risk factors.
Nitroglycerin
- A potent vasodilator that improves blood flow to the heart muscle and relieves pain.
- Common adverse side effect of nitroglycerin is a headache but nitroglycerin should be used carefully in patients with low blood pressure (less than 90 mm Hg).
- Administer as directed. Ensure mouth is moist, tongue lies still, and saliva is not swallowed until the tablet dissolves.
- Medication is carried securely in an original container and should be refreshed every 6 months.
- Patient should sit down for a few minutes after administration to avoid hypotension and syncope.
Acute Coronary Syndrome (ACS) and Myocardial Infarction (MI)
- An urgent situation characterized by an acute onset of myocardial ischemia that can result in myocardial death if not promptly treated.
- Unstable angina, non-ST segment elevation MI (NSTEMI), and ST segment elevation MI (STEMI) are part of the ACS spectrum.
Percutaneous Coronary Intervention (PCI)
- A surgical procedure used to open a blocked coronary artery and promote perfusion in a patient with STEMI.
- Door-to-balloon time is the time from a patient's arrival in the emergency department (ED) to the time PCI is performed, which should be under 60 minutes.
- Immediate PCI is recommended for patients with STEMI to improve patient outcomes.
Thrombolytic Therapy
- Thrombolytics dissolve blood clots, not just those in the coronary arteries; not recommended if previous hemorrhagic stroke or major surgery is present.
- Thrombolytics reduce the patient's ability to form blood clots and place them at risk for bleeding. Avoid intramuscular injections, continuous use of noninvasive blood pressure cuffs during this time.
Cardiac Rehabilitation
- A program for patients recovering from cardiac events to improve their health and prevent future events. This involves phases I, II and III: I-Inpatient Phase, II-outpatient cardiac rehabilitation which lasts 3–6 weeks and may last up to up to 12 weeks, and III-long-term outpatient phase (Post-Cardiac).
Vascular Disorders and Problems of Peripheral Circulation
- Peripheral arterial occlusive disease (PAOD) or peripheral artery disease (PAD) - characterized by intermittent claudication (pain during exercise that is relieved by rest), ischemic rest pain (worse at night), and pain elevation, pain reduction when extremity is in a dependent position.
- Assessment of pain, numbness, coldness, skin changes (ulcerations, gangrene), and diminished or absent peripheral pulses.
- Treatment options include exercise therapy, weight reduction, and medication (pentoxifylline or cilostazol, antiplatelet agents).
Venous Thromboembolism (VTE)
- Includes deep vein thrombosis (DVT) and pulmonary embolism (PE).
- Virchow's triad (venous stasis, altered coagulation, and blood vessel injury) are factors that play a significant role in VTE development.
- Symptoms include edema and swelling of the affected extremity, tenderness, warmth, pain or tenderness with redness and warmth in involved area.
- Assessment involves differences in leg circumference bilaterally from the thigh to the ankle, increased surface temperature of legs, particularly the calf or ankle.
- Prevention using graduated compression stockings, intermittent pneumatic compression devices, and early mobilization and leg exercises; treatment options involve anticoagulant therapy
Hypertension:
- Hypertension is defined by a systolic blood pressure (SBP) of 140 mm Hg or higher, or a diastolic blood pressure (DBP) of 90 mm Hg or higher.
- It is a chronic condition without symptoms, risk factors include advancing age, African American ancestry, a history of smoking, high alcohol intake, sedentary lifestyle.
- Clinical manifestations include retinal and other eye changes, renal damage, myocardial infarction, cardiac hypertrophy, and stroke.
- Assessment and diagnostic findings include history, physical examinations, laboratory tests (urinalysis, blood chemistry to check sodium, potassium, creatinine, cholesterol levels), ECG.
- Lifestyle modifications and pharmacologic therapies are part of management strategies.
Hypertensive Crises
- Hypertensive emergency occurs with blood pressure above 180/120 when prompt treatment in an intensive care setting is needed due to serious target organ damage.
- Hypertensive urgency is high blood pressure that requires a reduction of blood pressure over 24-48 hours to avoid organ damage.
Cardiomyopathy
- Cardiomyopathy is a progressive series of events that involves myocardial damage leading to impaired cardiac output, heart failure, and/or dysrhythmias.
- Clinical manifestations include dyspnea on exertion, fatigue, orthopnea, peripheral edema, and nausea. Assessing for tachycardia and extra heart sounds (S3, S4), echocardiogram, low sodium diet, exercise/rest regimen and heart transplantation.
Pericarditis
- Idiopathic Inflammation of the pericardium, infection or due to disorders of connective tissues: Systemic lupus erythematosus, rheumatic fever, rheumatoid arthritis. After pericardiectomy, after acute myocardial infarction.
- Pain or discomfort, which is usually consistent but may worsen with deep inspirations and when lying down or turning..
- Most pronounced symptom is the creaky or scratchy friction rub is heard best when a patient sits down and leans forward.
- Nurses need to use the stethoscope to assess for a pericardial friction rub in the left lower sternal border in the fourth intercostal space. Intervention is to treat the symptom relief and identify the cause of inflammation.
Heart Failure (HF)
- A clinical syndrome involving structural and/or functional cardiac disorders causing impaired ventricles to fill or eject blood which is characterized by fluid overload and/or inadequate tissue perfusion.
- Clinical manifestations often include right-sided failure (e.g., peripheral edema, hepatomegaly, ascites), and left-sided failure (e.g., pulmonary congestion, dyspnea, cough, orthopnea and paroxysmal nocturnal dyspnea).
- Assessment and diagnosis include echocardiogram to calculate ejection fraction and valve dysfunction; chest X-ray, 12-lead ECG, serum electrolytes, blood urea nitrogen ,creatinine, liver function tests, thyroid stimulating hormone, complete blood count, BNP, routine urinalysis and cardiac stress testing or cardiac catheterization.
Nursing Interventions:
- Patient teaching, addressing medications/side effects, patient positioning, activity restriction, symptom monitoring, and home care instructions.
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Test your knowledge on cardiovascular complications and symptoms with this quiz. Assess your understanding of conditions associated with elevated jugular venous distension, low cardiac output, and acute arterial obstruction. Perfect for nursing students or healthcare professionals.
