Cardiac Alterations.docx

\~\~\~\~\~\~\~Cardiac Alterations\~\~\~\~\~\~\~ =============================================== **[Hypertension]** - - **[Pathophysiology:]** - - - - - - - **[HTN Complications:]** - +-----------------------+-----------------------+-----------------------+ |...

\~\~\~\~\~\~\~Cardiac Alterations\~\~\~\~\~\~\~ =============================================== **[Hypertension]** - - **[Pathophysiology:]** - - - - - - - **[HTN Complications:]** - +-----------------------+-----------------------+-----------------------+ | | **Primary HTN** | **Secondary HTN** | +=======================+=======================+=======================+ | Risk Factors: | A. Aging - \>65 years | a\. Precipitating | | | of age | disorders or | | | | conditions | | | b\. **Smoking** | | | | | b\. **Cardiovascular | | | c\. **Genetics** - | disorders** | | | influences the | | | | body's sensitivity | **c. Renal | | | to salt when | disorders** | | | endothelial cells | | | | are activated ---\> | d\. Endocrine system | | | inflammation is | disorders | | | then activated | | | | impeding the | e\. **Pregnancy** | | | body\'s ability to | | | | vasodilate | f\. **Medications** | | | | (e.g., estrogens, | | | d\. Gender | glucocorticoids, | | | | mineralocorticoids) | | | e\. Ethnicity | | | | | | | | f\. **Diet** | | | | | | | | g\. **Diabetes** | | | | | | | | h\. **Cholesterol** | | | | (Hyperlipidemia) | | | | | | | | i\. Stress | | | | | | | | j**. Sedentary | | | | lifestyle** | | | | | | | | K. Excess alcohol | | | | intake | | +-----------------------+-----------------------+-----------------------+ **[Manifestations:]** - **[Assessment/ Management:]** - - - - - - **[Nonpharmacological interventions:]** - - - - - **[Pharmacological interventions:]** **Medication therapy is individualized for each client**, and the selection of the medication is based on such factors as the client's age, presence of coexisting conditions, and severity of hypertension.  Some of the adverse effects of medications include: **\*\*\*\*\*The primary concern with administering potassium-retaining (sparing) diuretics is hyperkalemia.\*\*\*\*** **\*\*\*\*A persistent dry cough is a common complaint for those taking an ACE inhibitor, but this often subsides after a few weeks. Instruct the client to contact the PHCP if this occurs and persists.\*\*\*\*\*** **\*\*\*\*\*Vasodilators cause orthostatic hypotension. Instruct the client about safety measures when taking these medications, such as when rising from a lying to a sitting or standing position slowly.\*\*\*\*\*\*** **[Hyperlipidemia]** - - - **Normal Values for Serum Lipids (KNOW THIS!!!!)** Total Cholesterol \ - - - - - - **[Nursing Care for Stress Test:]** - - - - **[Diagnostic Tests:]** - - - **[Interventions:]** - - - - - - - - - **[Surgical Interventions:]** - - - - - - - **[Angina Management:]** - **[Myocardial Infarction (HEART ATTACK) ]** **TIME IS MUSCLE!!!!!!!** - - - - - - **MI Treatment:** - - - - - - - - - - - -  4\) PCI (Percutaneous Coronary Intervention) procedures that open up blocked coronary arteries, blood vessels that supply oxygen via blood to your heart muscles. 5\) CABG- Coronary Artery Bypass Graft medical procedure to improve blood flow to the heart. It may be needed when the arteries supplying blood to the heart, called coronary arteries, are narrowed, or blocked. **[Heart Failure]** - - - **Classification:** - - +-----------------------+-----------------------+-----------------------+ | | **[Right-Sided Heart | **[Left-Sided Heart | | | Failure:] | Failure:] | | | ** | ** | +=======================+=======================+=======================+ | **[Etiology:]{.underl | \- occurs when the | | | ine}** | right ventricle does | | | | not pump effectively. | | | | When the RV fails, | | | | fluid backs up into | | | | the venous system. | | | | This causes movement | | | | of fluid into the | | | | **tissues and | | | | organs(peripheral | | | | edema, abdominal | | | | ascites** | | | | | | | | **-** The most common | | | | cause of right-sided | | | | HF is left-sided HF. | | | | As the LV fails, | | | | **fluid backs up into | | | | the pulmonary | | | | system**, causing | | | | increased pressures | | | | in the lung | | +-----------------------+-----------------------+-----------------------+ | **[Clinical | Jugular venous | ↓ PaO2, slight ↑ | | Manifestations:]{.und | distention | PaCO2 (poor O2 | | erline}** | | exchange) | | | **Edema** (e.g., | | | | pedal, scrotum, | Crackles | | | sacrum) | (**pulmonary edema**) | | | | | | | Weight gain | Pleural effusion - | | | | **A buildup of | | | **Ascites** | fluid** between the | | | | tissues that line the | | | massive generalized | lungs and the chest | | | body edema | | | | | Changes in mental | | | Hepatomegaly | status | | | | | | | | Restlessness, | | | | confusion | | | | | | | | Shallow | | | | respirations | | | | | | | | ** Orthopnea** | | | | | | | | Nocturia | +-----------------------+-----------------------+-----------------------+ | **[Diagnostics:]{.und | \- Chest X-ray- | | | erline}** | Enlarged Heart and | | | | Pulmonary infiltrates | | | | | | | | \- **ECG: | | | | non-invasive dx tool | | | | to determine severity | | | | of HF, and | | | | distinguish between | | | | reduced EF or | | | | preserved EF via | | | | ultrasound | | | | technology** | | | | | | | | \- Cardiac Cath | | | | | | | | \- **Brain | | | | Natriuretic Peptide | | | | (BNP)** | | | | | | | | \- Secreted when | | | | there is an INCREASE | | | | pressure in the | | | | ventricle | | | | | | | | \- INCREASE IN HF | | | | | | | | \- Cardiac Enzymes | | | | | | | | \- Other labs-CBC, | | | | CMP, electrolytes, | | | | maybe troponin aid in | | | | dx of HF | | +-----------------------+-----------------------+-----------------------+ | **[Treatment:]{.under | \- | | | line}** | **Anticoags**(warfari | | | | n, | | | | heparin): prevent | | | | thromboembolism | | | | | | | | \- dysrhythmic drugs: | | | | treat dysrhythmias | | | | that cause decreased | | | | EF | | | | | | | | \- Beta Blockers: | | | | promote reverse | | | | remodeling caused by | | | | hypertrophy | | | | | | | | \- **Diuretics**: | | | | decrease fluid volume | | | | and generalized edema | | | | by increasing urine | | | | output | | | | | | | | \- Ace inhibitors: | | | | dilate vessels and | | | | increase blood flow | | | | through the body | | | | | | | | \- **Positive | | | | Inotropes | | | | (digoxin)**: | | | | increases | | | | contractility force | | | | and decreases HR | | | | | | | | \- **therapeutic | | | | range for digoxin is | | | | 0.5 to 2.0 ng/dL** | | | | | | | | - - | | | | | | | | \- | | | | **vasodilators**(Nitr | | | | oglycerin): | | | | dilate vessels | | +-----------------------+-----------------------+-----------------------+ | **[Nursing | **Shortness of | | | Interventions:]{.unde | Breath** | | | rline}** | | | | | - - - - - | | | | | | | | **Fluid overload** | | | | | | | | - - - | | | | | | | | Daily weights | | | | | | | | Symptom management | | | | | | | | Patient education | | +-----------------------+-----------------------+-----------------------+ **[Risk Factors:]** **HTN\*\*\*, CAD\*\*\*,** MI, Older adults, **Comorbidities** (DM, tobacco use, etc.) **[Etiology:]** - - - - **[Compensatory mechanisms:]** - - - - - - - **[Assessment:]** **Right- and left-sided heart failure:** - - - - - - - - **[Management:]** - - - -