heart exam 4

<p>Lungs............Damage to the myocardium of left ventricle Caused by : HTN, CMOP, aortic stenosis, coarctation of the aorta, myocarditis, mitral regurgitation, ischemia. Blood backs up from left ventricle into lungs</p> Signup and view all the answers

<p>Decrease in stroke volume....Left ventricle loses ability to contract. • Blood cannot be pushed into circulatio</p> Signup and view all the answers

<p>DIASTOLIC HF • Left ventricle loses ability to relax • Heart cannot properly fill with blood</p> Signup and view all the answers

<p>Peripheral edema also (Left-sided HR Atrial septal defect, cor pulmonale, Pulmonary HTN, pulmonary valve stenosis)Damage to the right ventricle myocardium can happen in right side</p> Signup and view all the answers

<p>Results in congestion or fluid build up • May be left or right-sided • Not all HF is CHF • Congestion can be in lungs or periphery</p> Signup and view all the answers

<p>Echocardiogram</p> Signup and view all the answers

<p>acute heart failure-Sudden, severe fluid congestion within lung alveoli Conceptual Concern: Gas Exchange///// signs and symptoms include-Pink, frothy sputum, severe dyspnea, coughing, rapid respirations, crackles, Anxiety/restlessness////Nursing actions include-itals, place patient in semi-Fowler or high-Fowler position, give O2 as ordered, medications as ordered</p> Signup and view all the answers

<p>IV medications – Nitro – Lasix – Morphine – Diuretics/Complications: arrhythmias and cardiac arrest</p> Signup and view all the answers

<p>Pleural effusion • Thrombosis and emboli • Pulmonary edema • Arrhythmias • Liver damage • Kidney damage or failure • Anemia</p> Signup and view all the answers

<p>Clinical assessment I&gt;100BNP Indicate kidney damageBUN/creatinine Indicate liver damageliver enzymes Heart may appear enlarged, and fluid build up may be visibleChest X-ray Can help diagnose arrhythmias that may be causing HFECG Distinguishes systolic from diastolic HF, measures EFEchocardiogram- Can diagnose CAD, obtain EF Coronary angiogram- Small piece of heart muscle takenMyocardial Biopsy-</p> Signup and view all the answers

<p>Improve the heart's pumping ability/Identify and correct underlying cause. • Increase strength of heart’s contraction. • Maintain optimum water and sodium balance. • Decrease heart’s workload</p> Signup and view all the answers

<p>O2 • Activity • Sodium Restriction – &lt;2,000mg/day • Fluid restriction • Decrease weight – Report weight gain of 2 pounds in one day • Daily weights • Medications</p> Signup and view all the answers

<p>First-choice • Used for vasodilation effects, decreases afterload ACE Inhibitors- enalapril (Vasotec), lisinopril (Zestril)</p> Signup and view all the answers

<p>Entresto////Newer class, shown to reduce hospitalizations and deaths from chronic HF • Combo drug of valsartan/sacubitril, often used in conjunction with beta blockers and diuretics Beta Blockers – Carvedilol (coreg), Metoprolol (lopressor), • Reduce adverse effects of SNS- lower HR and BP</p> Signup and view all the answers

<p>Block effects of aldosterone-which causes sodium and fluid retention), reduce fluid volume</p> Signup and view all the answers

<p>neprilysn and entresto</p> Signup and view all the answers

<p>Strengthen ventricular contraction, increasing CO • Be aware of signs/symptoms of Digoxin toxicity • N/V, diarrhea, arrhythmias, vision changes, decreased appetite, confusion • Therapeutic range 0.8- 2ng/mL</p> Signup and view all the answers

<p>ECMO</p> Signup and view all the answers

<p>Increase circulation to coronary arteries</p> Signup and view all the answers

<p>Pacemaker</p> Signup and view all the answers

<p>end stage disease</p> Signup and view all the answers

<p>Ventricular assistive device</p> Signup and view all the answers

<p>Assist cardiac pumping to maintain CO</p> Signup and view all the answers

<p>Arteriosclerosis involves the formation of plaque within arterial walls, while atherosclerosis is characterized by thickening, loss of elasticity, and calcification of arterial walls.</p> Signup and view all the answers

<p>hickening, loss of elasticity, and calcification of arterial walls Part of aging process</p> Signup and view all the answers

<p>ATHEROSCLEROSIS: PATHO CONT. A fatty streak forms on the lining of the artery Plaque has jagged edges that allow blood cells and other materials to adhere to wall Fibrous cap forms • Can tear or rupture and a blood clot forms which can block artery Vessel become narrowed from plaque buildup</p> Signup and view all the answers

<p>Age- – Men after 50, – women after menopause • Gender- – Men • Ethnicity- – African Americans • Genetics- – Family hx. of hyperlipidemia</p> Signup and view all the answers

<p>The formation of a blood clot that can potentially block an artery</p> Signup and view all the answers

<p>400 mg/dL</p> Signup and view all the answers

<p>otal cholesterol (&lt;200mg/dL) • &gt;200 associated with CAD • Measurement of HDL, LDL, and VLDL Triglycerides 40 – 160 mg/dL • Critical value &gt; 400mg/dL • &gt;160 mg/dL LDLs (&lt;130mg/dL) • LDL contains both cholesterol and trigs and may deposit cholesterol directly onto walls of arteries/HDLs carry LDL to liver to be broken down and excrete</p> Signup and view all the answers

<p>Low-grade inflammation(&lt;10 mg/L Cardiac risk = &gt;3 mg/L)</p> Signup and view all the answers

<p>To assess heart function during physical activity</p> Signup and view all the answers

<p>Regular exercise</p> Signup and view all the answers

<p>Shows how heart works during physical activity • Can be on a treadmill/bike – If patient unable to exercise adenosine or another vasodilator used to open up vessels • Nuclear stress test – Small amounts of radioisotopes given IV – Photos taken and compared</p> Signup and view all the answers

<p>Assess for allergies prior – Obtain consent – When patient returns from cath lab • Keep on bedrest • assess vitals • entry site • 6 Ps</p> Signup and view all the answers

<p>Use of medications to reduce lipid levels</p> Signup and view all the answers

<p>Opens up the heart vessels for improved blood flow(Fruits and veggies, avoid trans fats, reduce saturated fats, reducing sugar and sodium)</p> Signup and view all the answers

<p>Smoking cessation</p> Signup and view all the answers

<p>Niacin</p> Signup and view all the answers

<p>increase conversion of cholesterol to bile acidsBile Acid Sequestrants: • Cholestyramine (Questran) • Colesevelam (WelChol) • Colestipol (Colestid</p> Signup and view all the answers

<p>Atorvastatin (Lipitor) • Pravastatin (Pravachol) • Simvastatin (Zocor) • Rosuvastatin (Crestor)</p> Signup and view all the answers

<p>Reduce triglycerides(Fenofibrate (TriCor) • Gemfibrozil (Lopid))</p> Signup and view all the answers

<p>Ezetimibe</p> Signup and view all the answers

<p>Increases unpredictably in frequency, occurs at rest, during sleep. Not relieved by meds or rest • Should be treated as emergency, can lead to MI</p> Signup and view all the answers

<p>Variant or Vasospastic angina(Caused by coronary artery spasms. Pattern is cyclical, lasts longer than stable)</p> Signup and view all the answers

<p>Spasms in walls of tiniest arteries. Pain may be more severe</p> Signup and view all the answers

<p>Discomfort, burning, fullness, pressure, squeezing Pain may radiate Heaviness in arms Women may have atypical symptoms • SOB, fatigue, nausea Lasts 5-15 minutes</p> Signup and view all the answers

<p>Reducing the workload of the heart(Sublingual – Acts in 1-2 minutes – Last 30-40 min. • 1 Q5min x 3 • Side effects: Hypotension, headache)</p> Signup and view all the answers

<p>Includes unstable angina and MI • Caused by sequence of inflammatory processes – Thrombus formation leading to reduced blood flow (Unstable angina) – Partial or complete occlusion of coronary artery (MI) • NSTEMI or STEMI</p> Signup and view all the answers

<p>STEMI</p> Signup and view all the answers

<p>The extent of heart muscle damage/STEMI- Most serious, affects full thickness of heart • NSTEMI- Less serious, blockage is usually partial--Results in death of heart muscle – 80-90% of time caused by thrombus formation • Ischemic injury happens over hours before complete necrosis takes place • Area of heart affected depends on coronary artery affected/Time is muscle!!! • Scar tissue may form in the damaged area</p> Signup and view all the answers

<p>Longer duration and sudden onset/Chest pain – New – Worse – Sudden – Occurs at rest, while asleep, with little exertion – Lasts longer than stable angina – Not relieved by medicine • Usually caused by atherosclerosis, which can rupture leading to blood clot • Should be treated as an emergency, can lead to MI</p> Signup and view all the answers

<p>The importance of quick diagnosis and management in ACS</p> Signup and view all the answers

<p>Heaviness, pressure, tightness, burning, constriction, or crushing pain- “elephant sitting on my chest” – Substernal or retrosternal, may radiate • Fatigue • Weakness • SOB • Anxiety • SNS is activated – Low BP – Elevated HR – Diaphoresis – Cool, Clammy, gray skin • Nausea/vomiting</p> Signup and view all the answers

<p>Denial common – Wait to seek care • “Time is muscle” – Call 911 – Do not drive self or ride with others – Reperfusion time critical • Chew one uncoated adult aspirin</p> Signup and view all the answers

<p>Troponin I (&lt;0.03 is normal) • The more damage the higher number will be Myoglobin and creatine kinase- (CK)- MB • Not as sensitive as Troponin EKG- • Look at ST segment Magnesium and potassium</p> Signup and view all the answers

<p>MONA TASS-morphine oxygen nitro aspirin, thrombo, anti, stool soft, sedatives</p> Signup and view all the answers

<p>Cardiac catheterization – Balloon angioplasty – Percutaneous coronary intervention (PCI) • Coronary Artery Bypass Graft (CABG)</p> Signup and view all the answers

<p>ntermittent Claudication- Pain in calves with activity Paresthesia Thin, shiny, and taut skin Loss of hair on the lower legs Diminished or absent pedal, popliteal, or femoral pulses Pallor of extremity when elevated, reddish-purple when dependent Cool skin Thickened toenails Dry, flaky, scaly skin Decreased sensation Pain at rest</p> Signup and view all the answers

<p>Ankle-brachial index (ABI)</p> Signup and view all the answers

<p>COMPLICATIONS • Atrophy of the skin and underlying muscles • Delayed healing • Wound infection • Tissue necrosis • Arterial ulcers • Amputation</p> Signup and view all the answers

<p>Smoking Hyperlipidemia Hypertension Diabetes mellitus Elevated BMI Family history of atherosclerosis Age Ethnicity- African Americans</p> Signup and view all the answers

<p>Intermittent Claudication</p> Signup and view all the answers

<p>Age Male gender Smoking HTN Atherosclerosi s Family history High cholesterol Elevated BMI</p> Signup and view all the answers

<p>Fusiform aneurysm.....................................Saccular • Bulges on one side of arterial wall Saccular • dilation of entire circumference Fusiform • Cavity is formed from tear in artery wall Dissecting</p> Signup and view all the answers

<p>Pulsatile massOften asx Pulsatile mass Bruit Back or flank pain Abdominal pain, feeling of fullness</p> Signup and view all the answers

<p>Abdominal ultrasound</p> Signup and view all the answers

<p>Lifestyle changes • Surgery – Dilated aorta section is removed, graft sutured in place • Endovascular aneurysm repair (EVAR) – Minimally invasive – Catheter threaded through femoral artery, stent and graft placed to support aneurysm</p> Signup and view all the answers

<p>Aortic dissection • Rupture—serious complication – into retroperitoneal space: • Sudden, severe back pain • Cool, clammy skin • Bleeding may be tamponaded by surrounding structures – into thoracic or abdominal cavity: • Massive hemorrhage • Usually don’t make it to the hospital</p> Signup and view all the answers

<p>Usually not making it to the hospital</p> Signup and view all the answers

<p>Tear occurs Blood “tracks” between inner and middle layer Inner and middle layers separate (dissect) Systolic pulsation ↑ pressure on damaged area Further ↑ dissection May occlude major branches of aorta</p> Signup and view all the answers

<p>AORTIC DISSECTION: S/SX sudden, severe Something is sharp or tearing in chest Pain weakened or absent pulses Cardiovascular decreased LOC dizziness syncope Neurologic dyspnea Respiratory More likely to present with hypotension and vague symptoms. Geriatric presentation</p> Signup and view all the answers

<p>Cardiac tamponade – Life-threatening – Blood escapes from dissection into pericardial sac • Hypotension, muffled heart sounds , narrowed pulse pressure • Rupture of Aorta – Hemorrhage, can lead to death – Can hemorrhage into mediastinal, pleural, or abdominal cavity, retroperitoneal space • Occlusion of arterial supply to organs (spinal cord, renal, abdominal)</p> Signup and view all the answers