Cardiology - Nursing Seminar 1 PDF

lOMoARcPSD|29860659 Cardiology- Nursing Nursing Seminar 1 (Phinma Upang College Urdaneta) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Viea Pacaco Siva ([email protected]) ...

lOMoARcPSD|29860659 Cardiology- Nursing Nursing Seminar 1 (Phinma Upang College Urdaneta) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Viea Pacaco Siva ([email protected])  lOMoARcPSD|29860659 CARDIOLOGY NURSING CARDIOVASCULAR SYSTEM → It is a closed system BLOOD VESSELS Closed system → once opened → bleeding → Responsible for tissue perfusion bringing blood to the Characteristics different parts of the body → Very vital system of the body → Resistance vessels → higher pressure Reproductive system - the system not vital for inside individual survival; but vital for the survival of the Arteries Bleeding: spurting population/reproduction → Thickest muscular layer → Largest artery: Aorta TISSUE PERFUSION → Capacitance vessels → Blood - Normal: 5-6L Thinner muscular layer → wider ↓blood volume → ↓tissue perfusion → shock lumen → lower pressure (less (hypovolemic shock) Veins resistance than the artery) Shock is a condition characterized by inadequate → Largest vein: Inferior vena cava (bigger tissue perfusion leading to multiorgan dysfunction than aorta) → Heart - pumping blood ↓pump → cardiogenic shock → Distributing vessels Causes of Cardiogenic Shock: → Called exchange vessels 1. Coronary causes: MI, CAD and all its Where gasses and nutrients exchanges complications Capillaries Made of only 1 layer: Tunica intima 2. Non-coronary causes: Other cardiac → Have the largest surface area (occupy conditions like congenital heart disease, most of the body) rheumatic heart disease → The smaller the capillaries → pressure is 3. Obstructive shock: compression at the heart being distributed → ↓pump ▪ E.g., tension pneumothorax (air goes Arteries Veins Capillaries inside the lungs → ↑pressure → compression of the heart → obstructive Material shock); occurs suddenly especially with Send blood Send blood to exchange Function from heart heart with trauma tissues ▪ Pleural effusion - slowly compresses the heart → symptomatic to patient; not Pressure High Low Low suddenly occurs, thus not an obstructive shock Extremely → Blood vessels - distribute blood to different parts of the Lumen narrow Narrow Wide body Diameter (one cell wide) Extremely Wall Thick Thin thin (single Thickness cell thick) Three: Three: One → Tunica → Tunica → Tunica Adventitia Adventitia Intima Wall Layers → Tunica → Tunica Media Media → Tunica → Tunica Intima Intima Muscle & Elastic Large amounts Small amounts None Fibers Arteries - carry oxygenated blood to different parts of the body except pulmonary artery Valves No Yes No Veins - carry unoxygenated blood back to the heart except pulmonary vein Lined by smooth muscles Additional Note: o Smooth muscles contract → blood vessels Arteriovenous (AV) Malformation → Cause: Idiopathic; Congenital Defect constrict → Affects the neurovascular system o Smooth muscle relax → blood vessels dilate → Occur in the cerebral vessels Maintains the vascular tone → Abnormal blood vessel → may rupture → bleed → can o Loss of vascular tone → vasodilation → ↓BP → cause hemorrhagic stroke shock (distributive/circulatory shock) o Causes of Circulatory Shock: 1. Infection → inflammation → massive vasodilation → septic shock 2. Allergy → inflammation → massive vasodilation → anaphylactic shock 3. Spinal cord injury → neurogenic shock Downloaded by Viea Pacaco Siva ([email protected])  lOMoARcPSD|29860659 → Risk factors: 1. Age: the blood vessels becomes less elastic when we grow older (>60) 2. Family history 3. Sedentary lifestyle 4. Smoking 5. Alcohol 6. Stress 7. Diabetes Mellitus 8. Obesity 9. Hypertension: most important risk factor o Blood pressure: pressure exerted by the blood Walls of an Artery and Vein against the walls → vessel distends → → Tunica intima - inner layer hardened blood vessel → cannot distend → d/t → Tunica media - smooth muscle layer continuous pressure by the blood → distends the outer wall of the blood vessel → aneurysm → Tunica externa - outer layer; wall of the aorta o Ascending Aorta Arteries o Descending Aorta → Create pulses ▪ Thoracic aortic aneurysm → Assessing pulses, assess the arterial function ▪ Abdominal aortic aneurysm (AAA) → Grading: → Signs and Symptoms: asymptomatic 0 - absent AAA: pulsating mass in the abdomen +1 - weak o Thrill can be palpated in thinner clients (elderly) +2 - normal → Complication: rupture → bleed → hypovolemic shock +3 - increased → death +4 - bounding → Sign of impending rupture → Normal pulses → good blood flow → good circulation Dissecting aortic aneurysm (napunit) - tearing of the wall VASCULAR DISORDERS Important RF: uncontrolled hypertension → Diseases of the blood vessels → Invasive Diagnostic test: Angiography (definitive) Done by cardiac catheterization (use of dye) → Non-Invasive Diagnostic Test: Ultrasound (Doppler/Duplex) Non-invasive but definitive ANEURYSM → Arterial problem → Abnormal dilation and sac formation in the wall of an artery → Causes: Congenital Aneurysm - present at birth o Common location: Cerebral vessels o Most common cause of hemorrhagic stroke in young people Acquired Aneurysm - developed → Type A: ascending aorta is involved o Common location: Aorta → Types of Aneurysm: Type I: ascending and descending Type II: ascending only Saccular Aneurysm Fusiform Aneurysm → Type B: descending aorta is involved Type III: descending only Ruptured Aneurysm o Most common type of aneurysm that causes death eventually o Shock: hypovolemic shock Aortic Aneurysm → Etiology: Atherosclerosis Athero → Atheromatous plaque Sclerosis → Hardening → Fatty deposits in the ascending or descending aorta → hardening d/t calcium deposition Fatty deposits may start from childhood o Fat will not dissolve in children especially if they have sedentary and unhealthy lifestyle Bad cholesterol (LDL), nicotine and tar can be fatty deposits Downloaded by Viea Pacaco Siva ([email protected])  lOMoARcPSD|29860659 Dissecting Aortic Aneurysm Hair follicles die Intervention)/Inspe Dissecting (no blood ct Dissecting Ascending Dissecting Dissecting supply) → SKIN – DARK, CYANOTIC, Aortic Aortic Thoracic Aortic Abdominal → PULSES – MAY BE PIGMENTED Aneurysm Aortic Aneurysm (Ascending Aneurysm Aneurysm ABNORMAL → PULSES – NORMAL BUT Aorta) Arteries create DIFFICULT TO PALPATE pulses Veins are affected; → No edema arterial function is No blood flow normal SIGNS AND Severe chest Severe Severe low → Arterial ulcer → With edema SYMPTOMS pain epigastric pain back pain Can result to d/t ↑pressure in vein → gangrene (even leaking of fluid out of though patient the interstitial space Type B: has no DM) → Venous ulcer Type A: medical ward If amputation is Can result to gangrene surgery ASAP (control BP not made → (even though patient (high risk for first) infection → has no DM) rupture) → Monitor septic shock If amputation is not → Repair of BP Characteristics made → infection → aneurysm: → Surgery : septic shock Characteristics: MANAGEMENT coiling, has higher o Small but clipping, risk than deep with o Larger lesions with repair controlling circumscrib irregular borders BP ed edges o Several (ginupit) granulation tissues → Important health teaching after surgery: o No (surrounded by live a healthy lifestyle granulation dark skin) → Manage risk factors: tissues → Nursing Diagnosis: Weight reduction (clean) Ineffective venous Avoid stress o Very painful circulation Smoking cessation (ischemia + Acute pain Avoid alcohol wound) Risk for impaired skin Exercise regularly → Nursing Diagnosis: integrity Ineffective Impaired skin integrity peripheral Risk for infection PERIPHERAL VASCULAR DISEASES (PVD) - Vascular (sepsis) tissue perfusion insufficiency Acute pain Risk for shock (septic → Affecting the small and medium sized arteries and veins Risk for shock) usually in the upper and lower extremities impaired skin → Nursing Intervention: → Commonly affects lower extremities integrity Position: Elevate the → Blood flow (artery): going down → oxygenated blood Impaired skin legs → Blood flow (vein): going up → unoxygenated blood integrity a. Arterial peripheral disease (PAD) - Arterial Risk for Insufficiency infection o Arteriosclerosis obliterans (ASO) (sepsis) ▪ Obliterans means to occlude/obstruct Risk for shock o Raynaud’s disease (septic shock) ▪ Most commonly affects the upper → Nursing extremity intervention b. Venous disorders - Venous Insufficiency Position: dependent o Varicose veins (reverse o Deep vein thrombosis (DVT) Trendelenburg) ▪ AKA VTE - venous thromboembolism c. Buerger’s Disease o AKA Thromboangiitis obliterans PERIPHERAL ARTERIAL DISEASE (PAD) o Thrombus and inflammation of the small and medium sized arteries and veins Arteriosclerosis Obliterans (ASO) → Affects lower extremities → Hardening of the small arteries and plaque formation VASCULAR INSUFFICIENCY (nicotine accumulation) Have atherosclerosis as well ARTERIAL VENOUS INSUFFICIENCY → Etiology: idiopathic INSUFFICIENCY → Risk factor: Age: 60 years old and above (oldies) → LEG PAIN → LEG PAIN Family history Cause: d/t Cause: Blood cannot Sedentary lifestyle ischemia go up → ↑pressure in Smoking Severe pain the veins → venous Alcohol associated with congestion → pain Obesity claudication The higher the (more pain upon pressure → injury in Hypertension walking) the blood vessel → Diabetes Mellitus → SKIN – PALE, inflammation → High fat/cholesterol diet THINNING OF HAIR phlebitis (inflammation → Commonly affects males d/t no blood of the vein) → Lower extremities are commonly affected flow Less severe than → Signs and symptoms: o Blood arterial Leg pain carries o Management: Claudication heat Assess (Priority Nursing Cool, pale skin Thinning of hair Downloaded by Viea Pacaco Siva ([email protected])  lOMoARcPSD|29860659 No edema Systemic Lupus Erythematosus → Nursing diagnosis: ineffective peripheral tissue Scleroderma - hardening of the skin (chest, hands); perfusion exhibits CREST syndrome → Management: o Difficult to treat d/t unknown cause 1. Position the legs dependently o CREST syndrome - collection of signs and 2. Manage risk factors: symptoms o Weight reduction ▪ Calcinosis - deposition of calcium in soft o Avoid stress tissues → hardening of the skin o Smoking cessation ▪ Raynaud’s phenomenon o Avoid alcohol ▪ Esophageal dysmotility - no movement of o Exercise regularly esophagus (d/t calcium deposits → o Control BP, sugar hardening) 3. Avoid trauma (wound will not heal) ❖ Possible of GI, nutrition problem 4. Skin care ❖ Risk for aspiration 5. Pain reliever (NSAIDs) ▪ Syndactyly - fusion of hands and fingers 6. Vasodilators are rarely given (dilate the normal (creases and lines are nawawala; weblike) vessels only) ▪ Telangiectasia - abnormal vein formation in o The doctor will assess the effectivity first before the skin giving vasodilators o Affects young adult women (18-25) 7. Amputation The disease is being treated in Raynaud’s phenomenon Raynaud’s Disease Additional Notes: → Atherosclerosis Affects big vessels → Frostbites happen when there is exposure to extremely cold temperatures (can happen to anyone) while raynaud’s occur with just a slight drop of temperature → Condition characterized by arteriolar vasospasm (smooth muscle contract → blood vessels dilate) Test Taking Strategies: → AKA “Blue White Red Disease” → “Always” - usually wrong → Reversible → Do not memorize questions and answers, → Etiology: idiopathic understand them! - Doc. Arreglo ✨ → Risk factors: Exposure to cold temperature VENOUS INSUFFICIENCY Smoking Stress Hypertension → More common in women → Upper extremities are commonly affected than lower extremities → Signs and Symptoms: Vasospasm → blue (cyanosis) o Severe vasospasm → white Pain Paresthesia (numbness and tingling sensation) o Reversible → vasodilation → increased blood flow → red Varicose Veins → Nursing diagnosis: → Involves superficial veins of the lower extremities Ineffective peripheral tissue perfusion → Abnormal dilation and tortuous formation of the Disturbed sensory perception superficial veins of the lower extremity (kulot kulot) Risk for injury ↑pressure → distention Impaired skin integrity → Irreversible Risk for infection → Valves direct the flow of blood up → Management: → Cause: Incompetent valves (destruction of valves) 1. Avoid exposure to cold temperature → Risk factors: o Warm or heat application is prohibited d/t burn Prolonged standing injury (destruction of small blood vessels) Prolonged sitting 2. Always wear gloves and boots (especially if living in Prolonged crossing of legs (impediment in the flow a cold weather) of blood) 3. Keep the heat in the environment up Obesity 4. Avoid smoking Pregnancy (enlarging uterus impedes the upward 5. Avoid stress flow of blood) 6. Control BP → Signs and Symptoms: 7. Pain relievers (NSAIDs) Leg pain d/t venous congestion and phlebitis 8. Vasodilators are given as ordered (Diltiazem) d/t o Injury to the wall → inflammation → phlebitis vasospasm Edema o Monitor BP Skin - dark, pigmented, cyanotic 9. Skin care → Nursing Diagnosis: 10. Avoid trauma Ineffective venous circulation 11. Amputation Acute pain → Raynaud’s Phenomenon - etiology is known; S/SX of Risk for impaired skin integrity raynaud’s disease are seen in different diseases such Impaired skin integrity as: → Management: Rheumatoid Arthritis 1. Prevention Downloaded by Viea Pacaco Siva ([email protected])  lOMoARcPSD|29860659 ▪ Avoid prolonged standing, sitting, crossing of → Thrombophlebitis legs Thrombus + inflammation → pain, redness, ▪ Weight reduction swelling, heat ▪ Exercise → Phlebothrombosis ▪ Compression stockings → to increase the Thrombus only, no inflammation → asymptomatic muscle tone → compress blood vessels → Assessment: direct the flow of blood upward o Homan’s sign: dorsiflexion of the foot causes 2. Medical Management: Sclerotherapy: hardening of pain in calf muscles blood vessels ▪ Not reliable ▪ Done in skin clinics ▪ If (+): do not repeat the test (repetition may ▪ Chemicals/ lasers are used; with sessions dislodge the thrombus → embolus) ▪ Chemicals (white) are injected making the ❖ Dangerous complication: pulmonary blood vessel hard → lessen discoloration of the embolism (IVC → RA → RV → PA → skin (match color of the skin) Lungs → sudden death) ▪ Blood flows to collateral veins Pulmonary hypertension → Collapse of the lungs ❖ Signs of Pulmonary Embolism: Dyspnea Tachypnea (shallow breathing) Chest pain ❖ Management: 1. Elevate HOB (semi-fowler’s) 2. Oxygenation 3. Refer o Severe obstruction = sudden onset of leg pain (a possible sign of DVT) 3. Surgical Management: vein stripping and ligation ▪ Blood flows to collateral veins → VTE to emphasize its dangerous complication → embolus → Etiology: Idiopathic → Risk Factors: Immobilization (muscles are not contracting) o Contraction of big muscles → valves → compress blood vessels → upward flow of blood → Virchow’s Triad = THROMBUS FORMATION 1. Stasis/stagnation (Slow blood flow) 2. Hypercoagulability (easy to form clot) 3. Endothelial injury (intima is lined with endothelial lining o Any of the situations may lead to thrombus formation (E.g., stasis + hypercoagulability) Susceptible (patients with viscous blood): o Bedridden o Comatose o Paralyze o Post operative o DM o Taking contraceptive pills (estrogen increases the viscosity of the blood) - Patients with PCOS → Management: Deep Vein Thrombosis – AKA Venous Thromboembolism 1. Prevention - very important AH! (VTE) o Mobilize! → Deep veins surrounded by big muscles of the leg → o Elevate the legs valves o Compression stockings/Antiembolic stockings → Thrombus: an abnormal clot (not dissolved) ▪ Brunner: TED Hose (Thromboembolic Deterrent Hose) 2. Manage DVT o Complete bed rest without bathroom privileges (immobilize the patient) ▪ Possible dislodge of thrombus with movement → embolus o Anti-coagulant (heparin) o NSAIDs o Surgery - endovascular surgery o Thrombolytic therapy ▪ Purpose: To dissolve the thrombus ▪ Urokinase, Streptokinase, Alteplase (USA) Downloaded by Viea Pacaco Siva ([email protected])  lOMoARcPSD|29860659 ▪ Contraindicated to patients with Contractility: Transmit impulses (Pacemaker/SA hemorrhagic stroke, bleeding disorders, node initiates impulse) ABN bleeding parameters: aPTT & aPT Conductivity o TED Hose: should be not fitting/too loose (snug Rhythmicity fit; kailangan magpasukat) Automaticity ▪ Worn for 6 months as ordered (can be Excitability removed when sleeping) → RA will receive blood from the upper portion of the body ▪ Purpose: To compress the muscles → through the SVC, while the lower portion of the body to divert the blood flow upward the IVC → bring unoxygenated blood to the heart → o Anticoagulant: Warfarin (Oral) unoxygenated blood will enter RA via the coronary sinus ▪ Purpose: To prevent further thrombus → RA will pump blood to RV passing the tricuspid valve formation (right AV valve) → RV will pump blood to the lungs → pulmonary artery → semilunar valve (pulmonic valve) BUERGER’S DISEASE → pulmonic valve → lungs for oxygenation → enter LA via the pulmonary vein (the only vein that carries oxygenated blood) → LA will pump blood to the LV passing the mitral/bicuspid valve (left AV valve) → LV will pump blood to the aorta → going through the aortic valve (left semilunar valve) → Valve: To prevent backflow When valves close, they produce heart sounds → Lungs: pulmonary circulation 25/9, pulmonary pressure Measured by cardiac catheterization (invasive) → Causes poor circulation in feet and hands → Aorta: systemic circulation More common on feet ↑pressure (110/70), determines BP → May lead to tissue death and amputation Can be measured indirectly through BP cuff → Irreversible → Affects BOTH arteries and veins Heart Sounds → AKA Thromboangiitis Obliterans (TAOB) → 4 hearts sounds (2 of which is heard and 2 of which is → Etiology: idiopathic unheard) → Risk factors: S1 - closure of the AV valves Important risk factor is smoking (gets worse the S2 - closure of the semilunar valves more you smoke) S3 - rapid ventricular filling Young adult men (18-25 years old) o Heard on conditions with cardiomegaly d/t Stress heart failure → rapid filling of ventricle → Thrombus + inflammation → arteries and veins o Ventricular (V3ntricular) gallop → Signs and symptoms: o “Lub-dub-dub” Leg pain and claudication (most important o Heard from children symptoms) S4 - atrial systole (atrial contraction) Dark skin o Heard when the atria hypertrophies → high Edema pressure o Atrial (4trial) gallop Pulses may be normal or abnormal (both arteries and veins are affected) o “Lub-lub-dub” → Nursing Diagnosis: Ineffective tissue perfusion - Backflow → ↑turbulence in flow of blood through PRIORITY (possible ischemia) the heart → murmur Ineffective venous circulation o “Shhhh” o Systolic murmur - contraction “lub shhh dub” → Interventions/Management: (murmur after first heart sound) 1. ***Avoid smoking and all forms of tobacco o Diastolic murmur - relaxation “lub dub shhh lub products*** dub shhh” 2. Avoid stress o As a nurse our primary responsibility is to 3. Avoid trauma determine changes in murmur 4. Skin care → S1 and S4 are audible using stethoscope 5. Wound care 6. Vasodilators are rarely given → S3 and S4 are inaudible and detected by machine 7. Amputation Valves HEART → Assessment: The bell of the stethoscope is used to assess heart sounds → Aortic valve: 2nd intercostal space right parasternal → Apex: point of maximum impulse area → A hollow muscular organ located in the middle → Pulmonic valve: 2nd intercostal space left parasternal mediastinum (between the lungs) area → Pumps blood to the different parts of the body → Tricuspid valve: 4th intercostal space left parasternal → Muscular tissue area Downloaded by Viea Pacaco Siva ([email protected])  lOMoARcPSD|29860659 → Mitral valve: 5th intercostal space (between 5th and (+) Murmurs 6th) left midclavicular line (+) Dysrhythmia The point of maximum impulse (PMI) → Definitive Diagnosis: 2D Echocardiography Apical pulse (apex) → It the heart cannot compensate anymore; it will Closure of the mitral valve (S1) eventually fail VALVULAR HEART DISEASES Management for Valvular Disorders: → Non-coronary cardiogenic shock can occur 1. Valvuloplasty (repair) Valvular Insufficiency Valvular Stenosis Inability of the valves to close Inability of the valves to open completely → backflow → completely (narrowing) → regurgitation ↓cardiac output → cardiogenic shock (non- coronary) → heart failure → Etiology: Congenital o TOF: pulmonic stenosis Acquired o Rheumatic fever → RHD 2. Valvular replacement (a mechanical valve or fibrous o Endocarditis → valvular defects valve) → Presence of murmur → Compensatory mechanism: enlargement of the heart (cardiomegaly) → allows strong contraction → ↑cardiac output Cardiomegaly is irreversible (response to a pathologic condition) Physiologic cardiomegaly o Occurs d/t strenuous activities → the heart compensates to increase cardiac output o Normal to Athletes ▪ HR is low when asleep ▪ Cardiac endurance 3. Support cardiac function: Independent Intervention As long as the heart is compensating, the cardiac Provide rest output is normal Avoid stress - increases the demand for oxygen The heart will start to fail once it cannot Avoid infection - increases the demand for oxygen compensate anymore 4. Manage heart failure Mitral Valve Prolapse Valvular Repair → Cardiac catheterization → Balloon catheter → inflation → compress the valve → removed LAYERS OF THE HEART → Bulging/ballooning of the mitral valve onto the left atrium → Etiology: Unknown → Risk factors: Congenital Family history Common on females; young adult Stress → When it closes → mitral click/systolic click is heard at the APEX → Signs and Symptoms: Chest pain Palpitations (feeling of heart beating) Easy fatigability Syncope (pass out) → Management: Avoid caffeine or any stimulants; give beta blockers to manage palpitations → Complications: Mitral regurgitations Downloaded by Viea Pacaco Siva ([email protected])  lOMoARcPSD|29860659 Elevated Erythrocyte Sedimentation Rate (ESR) - systemic inflammation Culture and sensitivity → infection Coronary angiography AntiNuclear Antibody (ANA) Test - suggestive test for SLE; for autoimmune diseases o If (+): the cause of pericarditis is SLE Biopsy (if cancer is the cause) → Management Orthopneic Position (tripod/leaning forward) - priority; independent Pain reliever - NSAIDS Anti-inflammatory drugs - steroids → Endocardium - inner most layer Manage the cause Inflammation of the endocardium - endocarditis Prevent and manage complications: → Myocardium - middle layer o Pericardial effusion Inflammation of the myocardium - myocarditis; o Cardiac tamponade common in children; caused by coxsackie virus Pericardiotomy - opening of the pericardium → → Epicardium - outer most layer stent is placed to allow drainage of fluid into the Inflammation of the epicardium - pericarditis pericardial cavity (reabsorbed by the lymphatics → AKA visceral pericardium systemic circulation) → Parietal pericardium - protective layer o Done when there is recurrent pericardial → Pericardial sac effusion → Pericardial fluid - it decreases when ventricles contract Pericardiectomy - removal of the pericardial sac (to prevent compression of the heart) PERICARDITIS o Complication: dysrhythmias → Complications: Pericardial Effusion - accumulation of fluid in the pericardial sac (>20 ml) o Normal fluid: 15-20 ml o Constrictive pericarditis o Can lead to cardiac tamponade o Pericardiocentesis - Remove the fluid from the pericardium ▪ Done by the doctor ▪ The nurse assists the doctor ❖ Position - semi fowler’s ▪ X-ray and ultrasound guided to avoid → Inflammation of the pericardial sac puncturing the lungs (done before the procedure) → Etiology: ▪ ECG guided - done during Idiopathic pericardiocentesis Infection ❖ The needle is connected to the ECG to Trauma to the chest prevent puncturing of the heart Malignancy (sign of metastasis) Systemic Lupus Erythematosus (SLE) MI-induced pericarditis (Dressler’s syndrome) → Sign and Symptom Chest pain - most prominent clinical manifestation/symptom - subjective cue o Pericarditis chest pain - pain worsens with deep inspiration, lying down, or turning and relieved by sitting or leaning forward (Orthopneic/tripod position) o MI chest pain - constant (not affected by Cardiac Tamponade - life-threatening (leading to breathing or movement of the chest) shock) characterized by the inability of the heart to Friction rub (most common sign - objective cue) pump d/t excessive fluid in the pericardium o Swelling → ↑pressure when the ventricles (emergency; can lead to cardiogenic obstructive contract → friction rub shock) o Friction rub: assessed by auscultation at the o Manifestations (Beck’s Triad): 4th intercostal space left parasternal area (bell ▪ ↓BP d/t ↓cardiac output of the stethoscope) ▪ ↑jugular vein pressure → distended neck o Creaky, leathery, scratchy sound veins o Sound heard best at the end of expiration and ▪ Muffled/ distant heart sounds when the patient is sitting or leaning forward → Nursing Diagnosis: Acute pain related to inflammation of the pericardial sac → Intervention: Position: orthopneic (priority) - to relieve pain; lessens irritation to the wall → Diagnostic Tests 2D echocardiography (most definitive)- seen by the eyes Chest X ray (2nd option to 2D echo) - heart, sac, distention CBC - increased WBC → infection Downloaded by Viea Pacaco Siva ([email protected])  lOMoARcPSD|29860659 o Obstructive shock - no position will relieve it → Signs and Symptoms: o Call the doctor: Emergency pericardiocentesis Intermittent fever - most prominent systemic will be done; ECG guided manifestation ▪ Pericardiocentesis is effective when o Low immune system → weak blood → Beck’s triad disappears (↑BP, ↓venous bacteria enters → damaged valves → pressure, heart sounds are heard) proliferate in the endocardium ▪ Position after pericardiocentesis: semi o But patients with endocarditis can manifest no fowler’s to promote lung expansion fever d/t immunocompromised = altered level of consciousness may manifest ENDOCARDITIS Weakness Fatigue Malaise Chest pain (vague) ↑WBC ↑ESR → Nursing Diagnosis: (Systemic inflammation) Hyperthermia: fever Fatigue Activity intolerance Risk for infection Risk for shock (Septic/Cardiogenic) Acute pain: chest pain → Green particles: Vegetations/microthrombi Risk for fall/injury: fatigue malaise → It can also accumulate in different portions of the heart → Embolization → Inflammation of the endocardium Small thrombi may clogged small vessels → Cause: Bacteria → Group A Beta Hemolytic Some clogged blood vessels → rupture → bleeding Streptococcus (GABHS), Staphylococcus, Signs and Symptoms of Endocarditis secondary to pneumococci Embolization: FROMJANE Bacterial Endocarditis/Infective Endocarditis o Fever → Risk factors: o Roth’s spots - hemorrhages with pale centers Already has an existing cardiac condition (retina) → clogged → ruptured (congenital heart disease, valvular, rheumatic heart ▪ Assessed thru ophthalmoscope disease) o Osler’s nodes - painful nodules in finger pads Immunocompromised and toes Had undergone invasive procedure or surgery o Worsening of murmurs due to microthrombi in o Requires opening of the blood vessels (cardiac the valves catheterization) o Janeway lesions - painless macules on palms o Tooth extraction, dental extraction, and soles tonsillectomy o Anemia o Normal Spontaneous Delivery o Nail changes: Splinter hemorrhages - brownish o Any procedure that affects/punctures the streaks on fingernails and toenails blood vessels o Ecchymosis/embolization Poor dental hygiene, poor socioeconomic status Diagnostic test: → Pathogenesis: o Culture and sensitivity o CBC: ▪ Increased WBC ▪ Decreased RBC ▪ Decreased Hgb o Erythrocyte Sedimentation Rate (ESR) - elevated → indicates systemic inflammation o 2D echocardiography Nursing Management: 1. Manage fever - can be managed without pharmacological therapy since its only intermittent 2. Assess for changes in murmur q shift 3. Monitor vital signs 4. Support cardiac function ▪ Provide rest - to prevent increased O2 demand ▪ Avoid stress ▪ Avoid infection (e.g., UTI, pneumonia, bed sore) ❖ Further infection may aggravate the situation of the patient Medical Management: 1. Prevention - Most important management ▪ Administration of prophylactic antibiotic prior to any invasive procedure or surgery ▪ Penicillin/Erythromycin/Azithromycin ▪ Mitral Valve Prolapse (MVP) - no need for prophylaxis unless there is already mitral regurgitation ❖ All valvular defect need prophylaxis before invasive procedure is being done Downloaded by Viea Pacaco Siva ([email protected])  lOMoARcPSD|29860659 2. Antipyretic - for fever 3. Analgesic - for pain 4. Antibiotic as ordered 5. Support cardiac function 6. Manage heart failure 7. Prevent shock (septic/cardiogenic) CARDIOMYOPATHY (CDM) → Non coronary disease → Disease of the cardiac muscle → Etiology: Idiopathic → Irreversible → heart failure → Cannot given CCB: cannot contract anymore → → Cure: heart transplant → Types of Cardiomyopathy 1. Dilated Cardiomyopathy: Most common type BLOOD PRESSURE o Significant dilatation w/o hypertrophy → Classification of blood pressure for adults 18 years old o Diffused necrosis of the cardiac muscle (cell and above death) → What we consider as normal BP = 110/70 o Risk factors: → For elderly, expected to be higher >120/>80 ▪ Viral infection ▪ Pregnancy SYSTOLIC DIASTOLIC BP CLASSIFICATION PRESSURE PRESSURE Normal