Orthostatic Changes, Cardiac Assessment, and Arrhythmias: An Overview, Exams of Nursing

Download Orthostatic Changes, Cardiac Assessment, and Arrhythmias: An Overview and more Exams Nursing in PDF only on Docsity! NUR 242 Exam 4 - Cardiovascular What is the equation for cardiac output? - ANS CO = HR x SV What is preload? - ANS the heart is being stretched out What does preload reflect? - ANS how much fluid is in the heart What is afterload? - ANS resistance the ventricle must overcome to eject blood Example of increased preload - ANS CHF Example of increased afterload - ANS hypertension What is blood pressure? - ANS force of blood against vessel walls What is systolic blood pressure? - ANS amount of pressure generated by the left ventricle to distribute blood into the aorta with each CONTRACTION of the heart What is diastolic blood pressure? - ANS amount of pressure against the arterial walls during RELAXATION of the heart What is the equation for MAP? - ANS 2(diastolic) + systolic / 3 What is the minimum the MAP can be to maintain adequate perfusion? - ANS no less than 60 What is another name for orthostatic changes? - ANS postural hypotension A decrease of more than 20 mmHg systolic or more than 10 mmHg diastolic pressure with an increase in heart rate - ANS orthostatic change How do you measure orthostatic changes? - ANS Check blood pressure in the following order: after laying supine for 3 minutes, after sitting for 1 minute and standing **Keep cuff in same place** What precautions are important for a patient experiencing orthostatic changes? - ANS fall Who is at risk for orthostatic changes? - ANS prolonged bed rest, medications, dehydration, volume depletion, autonomic nervous system disorders Cardiovascular assessment - ANS general apperance, skin, weight, edema, extremities, blood pressure Markers of myocardial damage - ANS troponin, creatinine kinase, CKMB, myoglobin, serum lipids, homocystine levels Normal lipid levels - ANS Total cholesterol <200mg/dL, LDL (Cardiac pt) <70/dL, LDL (Non-Cardiac pt) <130/, HDL >40mg/dL, Triglycerides <150mg/dL Cardiac Diagnostic Tests - ANS ECG, Echocardiogram, Cardiac Catherization Nursing considerations for cardiac catherization - ANS informed consent, patent IV, allergies to iodine or shellfish, NPO, height, weight, sensations from dye, post procedure care (bed rest 6 hours, leg straight, assess vitals and pulse frequently) What is a normal ejection fraction? - ANS 55-65% What are the contraindications for cardiac catherization? - ANS due to use of dye - renal failure/insufficiency (cret >1.5) or metformin use in the last 48 hours Why is a cardiac catherization conducted? - ANS blockage in coronary arteries All rythm issues are ____________ related - ANS electrical/conduction P Wave - ANS atrial contraction / atrial depolarization QRS complex - ANS ventricular contraction / ventricular depolarization T Wave - ANS ventricular relaxation/ ventricular repolarization In order for a ryhtm to be sinus it must have: - ANS orginating from the sinus node with a normal P, QRS and T segment AND be between 60-100 bpm Sinus bradycardia - ANS originating from the sinus node, normal segments but slower ; rate less than 60 bpm Symptomatic bradycardia - ANS dizzy, faint, lightheaded, diophoretic, hypotensive Emergency treatment of bradycardia - ANS atropine 0.5 - 1mg IV Sinus tachycardia - ANS originates from sinus node, contains all the segments but is fast; rate > 100bpm Causes of tachycardia - ANS fever, pain, dehydration, hyperthyroid, anxiety, energy drinks, medications, illicit drugs What is the most common arrythmia? - ANS atrial fibrillation (Afib) What are the unique characteristics of Afib? - ANS no P wave, wavy baseline Why is the echocardiogram the best test for heart failure? - ANS reveals the structures of the heart, the heart function, and the ejection fraction What ejection fraction is considered failure? - ANS <40% Drug therapy for CHF - ANS loop diuretics, ACE, ARB, Beta Blocker, spirnolactone, digoxin What do diuretics do for CHF? - ANS decrease preload What do ACE and ARBs do for CHF? - ANS decrease preload and afterload What do beta blockers do for CHF?> - ANS decrease afterload What is the impact of digoxin when used for CHF? - ANS positive inotropic and negative chronotropic What does inotropic mean? - ANS contractility What does chronotropic mean? - ANS heart rate What medication class is contraindicated in CHF? - ANS calcium channel blockers What is first line treatment for CHF? - ANS diuretic + ACE or ARB + beta blocker What are the end stage interventions for CHF? - ANS BiV pacing, A1CD, Transplant, LVAD, Hospice What non-surgical options are there for heart failure? - ANS CPAP, biventricular pacing What surgical options are there for heart failure? - ANS heart transplant, ventricular assist device Interventions for heart failure - ANS improve gas exchange, I&O, daily weights, low sodium diet, fluid restrictions, medication compliance, smoking cessation, patient education on drug regimen and side effects Discharge instructions for patient with CHF - ANS Immediately report: weight gain, decrease in exercise tolerance, cold symptoms, excessive nocturia, dyspnea at rest, angina, increaed swelling Emergency complication of heart failure - ANS flash pulmonary edema: tachypnea, dyspnea, wheeze, crackles, wet cough, diaphoresis, anxiety, profound accessory muscle breathing and pink tinged sputum Flash pulmonary edema interventions - ANS remain with client, notify the provider, high folwer's position, supplemental oxygen, anticipate orders for loop diuretic, nitrates, and morphine, I&O, insert foley Desired blood pressure for people over 60 - ANS below 150/90 Desired blood pressure for people under 60 - ANS below 140/90 Essential hypertension risk factors - ANS obesity, smoking, race (African American), excessive and continuous stress, family history, hyperlipidemia, physical inactivity Secondary hypertension risk factors - ANS kidney disease, pregnancy, primary aldosteronism, Cushing's syndrome, medications Clinical manifestations of hypertension - ANS Asymptomatic-Headache,Flushed face dizziness Questions to ask when assessing someone with hypertension - ANS family history, dietary intake, occupation, BMI, exercise habits Diagnostic assessments for hypertension - ANS ECG, kidney function testing, UA Lifestyle changes important for patient with hypertension - ANS exercise, weight reduction, DASH diet (reduced caffiene, sodium, alcohol, lipids), smoking cessation, stress management Ongoing management of hypertension - ANS blood pressure diary, vision testing, and surveillance kidney disease Medications used to treat hypertension - ANS diuretics, angiotensin converting enzyme inhibitors, angiotension receptor blockers, calcium channel blockers, renin inhibitors, central alpha agonists and beta blockers Hypertensive crisis - ANS severe headache, extremely high blood pressure, dizziness, blurred vision, short of breath, epistaxis, chest pain Interventions of hypertensive crisis - ANS semi fowlers, calm envirpnment, critical care admission, monitor blood pressure q 15-30 minutes Treatment of hypertensive crisis - ANS IV nicardipine, IV nitroglycerin; as needed IV labetalol arteriosclerosis - ANS artery walls become thicker, harder and less elastic Atherosclerosis - ANS artery becomes hardened from plaque; impact the large and medium arteries (aorta, renal, coronary, cerebral, carotid, femoral, iliac) Risk factors for athersclerosis - ANS Low HDL, high LDL, increased triglycerides, obesity, diabetes, smoking, stress, genetics, ethnicity (African American & Hispanic), oler age Physical Exam findings for patient with atherosclerosis - ANS hypertensive, diminished peripheral pulses, cool extremities, delayed capillary refil, presence of bruit (carotid or femoral) Labs findings associated with athersclerosis - ANS elevated cholesterol, elevate HgA1C Diagnostics associated with atherosclerosis - ANS carotid doppler, LE doppler, renal artery doppler, cardiac catherization Prevention of athersclerosis - ANS maintain normal B/P, smoking cessation, weight management, low fat, decreased sugar and fatty foods, DASH diet, increase physcial activity (3-4 time/wk), adherence to drug therapy peripheral arterial disease (PAD) - ANS disease of the arteries in the arms and legs, resulting in narrowing or complete obstruction of the artery Stages of Peripheral Arterial Disease - ANS 1 - pedal pulses may decrease 2 - intermittent claudication, occurs with exercise, relieved with rest 3 - ischemic rest pain, made worse be elevation of extremity, may wake patient from sleep, pain relieved by putting leg in dependent position 4 - necrosis or gangrene due to oxygen deprivation symptoms of peripheral artery disease - ANS pain, numbness, non-healing ulcers Physical exam findings of patient with peripheral artery disease - ANS diminished or absent peripheral pulses, cool and pale extremities, development of ulcers, paresthesias, less hair growth, dependent rubor (turns red when dangled) What do you do if you cannot locate a peripheral pulse? - ANS 1. Have a second nurse verify 2. if not found get the doppler 3. if still not found call healthcare provider diagnosis of peripheral artery disease - ANS ankle brachial (systolic BP) < 0.9, doppler study Management of peripheral artery disease - ANS anti-platelets, PDE inhibitor, interventional procedure (arterial bypass)