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Unit VIII Acutely Ill Clients with Cardiac Disorders

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Angina vs. Infarction cont.' Myocardial Infarction 'Crushing' unrelieved sub-sternal chest pain ... Acute Myocardial Infarction (AMI) ... – PowerPoint PPT presentation

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Title: Unit VIII Acutely Ill Clients with Cardiac Disorders


1
Unit VIIIAcutely Ill Clients withCardiac
Disorders
  • Wendy DuFour, RN, MN,CCRN
  • Assistant Professor of Nursing
  • Los Angeles Valley College

2
HYPERTENSION
  • The force exerted by the blood against the walls
    of the blood vessel and must be adequate to
    maintain tissue perfusion during activity and
    rest.
  • Arterial blood pressure
  • Cardiac output X Systemic vascular resistance

3
Systemic Vascular Resistance
  • Force opposing the movement of blood within the
    blood vessels.
  • The width or radius of the small arteries and
    arterioles determines vascular resistance.
  • If the vessels become smaller, SVR goes ? also
    known as________
  • If the vessels become larger, SVR goes ?.

4
Hypertensive Crisis
  • Severe and abrupt elevation in BP
  • Diastolic BP 120-130 mm Hg.
  • Concern is organ damage to heart, brain,kidneys,
    and aorta.
  • Usually more common in non-compliant or
    undermedicated HTN persons.
  • May be caused by illicit drug use such as cocaine
    or crack use.

5
Hypertensive Crisis Management
  • ??Blood pressure IV Nitroprusside
  • Monitor for hypotension
  • Prevent damage
  • Cause of crisis
  • Patient education
  • Medication management

6
Anti-hypertensives
  • Diuretics
  • Adrenergic Inhibitors
  • Central-acting antagonists
  • Peripheral acting antagonists
  • 8 blockers
  • ß blockers
  • Combined
  • Direct vasodilators
  • Angiotensin-Converting Enzyme Inhibitors
  • Angiotensin II Receptor Blockers
  • Calcium Channel Blockers
  • Lewis table 32-8

7
Anti-hypertensives
  • Duiretics- inhibit NaCl reabsorption within the
    kidney. Some may or may not spare K.
  • Nursing implications
  • Adrenergic Inhibitors- all work on peripheral
    sympathetic tone and response.
  • Nursing implications

8
Anti-hypertensives
  • Direct Vasodilators- work specifically on central
    venous or arterial tone.
  • Nursing implications
  • Angiotensin Inhibitors- inhibit or block action
    of angiotensin.
  • Nursing implications
  • Calcium Channel Blockers- block movement of
    extracellular calcuim into cells. What does
    calcium do?
  • Nursing implications

9
Remember this
  • Heart Rate (HR) X Stroke Volume(SV)
  • CARDIAC OUTPUT (CO)
  • IF YOUR CLIENT HAS AN ALTERATION IN ANY OF THE
    ABOVE, HR OR SV, THEN THE CO WILL BE AFFECTED

10
SOME BASICS
  • Normal heart rate-
  • Factors influencing changes in heart rate
  • Intact SA Node
  • Autonomic Nervous System
  • Stimulation
  • Norepinephrine
  • Epinephrine
  • Vagal
  • Compensation

11
SOME BASICS cont.
  • Pathologic Conditions-
  • Such as
  • Immune Response
  • Shock
  • Hypovolemic
  • Septic
  • Cardiogenic
  • Chapter 65 Lewis, Chapter 54, Morton

12
ITS EKG TIME!!
  • You know more than you think you do.
  • Components of a Normal EKG
  • Pwave, QRScomplex, STsegment, Isoelectrical
    Line
  • Atrial Depolarization
  • Ventricular Depolarization, Atrial Repolarization
  • Ventricular Repolarization

13
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16
Normal Values
  • PR Interval .12-.20ms
  • QRS .06-.12ms
  • QT Interval
  • Heart Rates
  • 60-100 Normal Sinus Rhythm
  • 40-60 Sinus Bradycardia
  • 100-150 Sinus Tachycardia

17
ABNORMAL EKGS
  • Not originating from the SA node
  • Originating in the SA node but then unable to
    travel normal pathway
  • Atrial fibrillation
  • Atrial flutter
  • Blocks 1st, 2nd degree type I II,
  • 3rd degree

18
ABNORMAL EKGS
  • Ventricular irritability
  • Ventricular Tachycardia
  • Ventricular Fibrillation
  • Also known as Sudden Death
  • May have Implantable Cardiac Defibrillator (ICD)
  • Goal is to shock and restart the heart and a
    normal conduction sequence (hopefully)

19
Nursing Management of Patients with Dysrhythmias
  • Assessment
  • ABCs
  • What is the patients current status?
  • Vital signs
  • How do I help them?
  • Keep Calm!!!!!
  • Activate EMS
  • CPR
  • Teaching if stable

20
Angina vs Infarction
  • Angina- In cardiac patients, caused by ischemia
    or decreased oxygen to the tissues resulting in a
    buildup of lactic acidosis.
  • Ache or Dull pressure
  • May radiate up neck or down L arm
  • Relieved by NTG (SL) or by rest
  • Confused with Indigestion
  • Review 33-12 for other causes

21
Angina vs. Infarction cont.
  • Myocardial Infarction
  • Crushing unrelieved sub-sternal chest pain
  • Requires IV drip of NTG that may or may not
    relieve CP
  • Responds to Morphine
  • Feeling of Impending Doom
  • S S of decreased Cardiac Output
  • Can lead to Cardiogenic Shock
  • Arrhythmias

22
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25
Acute Myocardial Infarction (AMI)
  • Severe, immobilizing chest pain not relieved by
    rest, medication, or position change.
  • Due to ischemia from lack of oxygen to a specific
    area of myocardial tissue.
  • May be caused by a blood clot
  • May be caused by an atherosclerotic plaque

26
Nursing Management of AMI
  • Assessment
  • Subjective
  • Pain- where, when, type, how long?
  • Nausea or other concerns?
  • Objective
  • VS
  • Rapid physical assessment focusing on Cardiac and
    Respiratory systems
  • Head to Toe

27
Nursing Management of AMI
  • Nursing Diagnosis
  • Decreased Cardiac Output
  • Ineffective tissue perfusion
  • Acute Pain Alteration in comfort
  • Anxiety
  • Altered coping
  • Altered level of consciousness
  • Activity intolerance
  • Powerlessness
  • Knowledge deficit

28
Nursing Management of AMI
  • Plan
  • Prevent complications of altered cardiac output
  • Maintain safety
  • Increase knowledge
  • Decrease pain
  • Lewis pg 826-27

29
Interventions for AMI
  • ABCs
  • MONA
  • Interpret Lab data
  • Troponin
  • BMP
  • CBC
  • Coags
  • Drugs Morphine, Heparin, Nitrates, ASA, Dopamine
    (blood pressure support)

30
Nursing Management of AMI
  • Preparing client for Cardiac Cath
  • Remember the dye used is nephrotoxic.
  • Check labs such as_____
  • Consents for catheterization, angioplasty and
    possible surgery.
  • Education! How will this help them with their
    pain and the AMI.

31
Nursing Care Post Angioplasty
  • Risk for Bleeding
  • Risk for Arrythmias
  • Altered urinary output
  • Fluid volume deficits
  • Decreased cardiac output
  • Potential for injury
  • Impaired physical mobility
  • Knowledge deficit

32
Cardiomyopathy
  • Disease of the heart muscle that affects the
    functional ability of the heart
  • Primary or Idiopathic- unknown origin
  • Secondary- from heart disease
  • Dilated- most common form
  • Restrictive
  • Hypertrophic - most common cause of sudden death
    in healthy young people.

33
Collaborative Management of Cardiomyopathy
  • Goal is to improve ventricular filling which
    leads to improved cardiac output.
  • ?contractility (force)
  • Relieving LV outflow obstruction.
  • Beta blockers or CA channel blockers
  • Antiarrythmias medications or
  • Implantable cardiac defibrillators
  • Long term treatment may include heart
    transplantation.

34
Pacemakers Defibrillators(ICD)
  • Support of conduction abnormality
  • Initiate stimulus
  • Maintain normal cardiac output
  • Does not help in contractility.
  • Single chamber, dual chamber, and biventricular
  • Treatment of life-threatening arrhythmias
  • Has shown to improve cardiac mortality rates.
  • Has pacemaker built in.
  • Can be single or bi- ventrical.

35
Nursing Care and Management
  • Nursing Diagnosis-______
  • Goal is to prevent lead dislodgement.
  • Nursing education is key!
  • Pain management
  • Impaired physical mobility
  • Anxiety- altered coping
  • Caregiver role strain

36
Inflammatory and Valvular Heart Disease
  • Infective endocarditis- an infection of the
    endocardial surface of the heart.
  • May be called Bacterial Endocarditis.
  • Lewis table 36-4, 36-5
  • Tends to effect the heart valves.
  • Strep or Staph are the main culprits.
  • Stroke is common
  • Congestive Heart Failure
  • Pulmonary Edema

37
Inflammatory and Valvular Heart Disease
  • Nursing assessment to include
  • subjective data- What brought them to seek
    medical attention?
  • C/O joint pain, fatigue, night sweats,
  • Objective data-
  • VS, Integumentary, Respiratory, Cardiovascular,
    Labs, Echo, EKG, Chest X-ray
  • Nursing Diagnosis- see Lewis pg. 891

38
Nursing Diagnoses
  • Alteration in Comfort
  • Decreased Cardiac Output
  • Impaired physical mobility
  • Self care deficit
  • Impaired tissue perfusion
  • Altered level of consciousness

39
Goals
  • Improve cardiac output.
  • Increase comfort.
  • Prevent hazards of immobility.
  • Increase knowledge.
  • Return client to optimal level of functioning.

40
Treatment of Endocarditis
  • Antibiotics- in hospital and possibly at home.
  • Supportive therapies for comfort, pain, decreased
    cardiac output, impaired gas exchange,
    hyperthermia.
  • Patient education and family support.

41
Acute Pericarditis
  • Inflammation of the pericardial sac.
  • Present much like AMI patient.
  • More noticeable with each breath.
  • Pericardial Friction rub
  • Complications may include pericardial effusion-
    an accumulation of excess fluid in the
    restrictive pericardial sac- Tamponade

42
Acute Pericarditis
  • Assessment
  • Subjective
  • Pain where, when, intensity, type
  • SOB due to pain?
  • Medical Hx
  • Objective
  • Vital Signs
  • Evidence of compensation or decompensation
  • Cardiac and Respiratory Assessment
  • Echocardiogram
  • Labs

43
Acute Pericarditis cont.
  • Nursing Diagnosis
  • Decreased cardiac output
  • Impaired tissue perfusion
  • Pain
  • Anxiety
  • Impaired physical mobility

44
Acute Pericarditis cont.
  • Medical Treatment drain fluid
  • Surgery or
  • Bedside procedure
  • Pain management
  • Nursing Goal maintain adequate cardiac output
    and monitor for complications

45
Valvular Disease
  • Aortic and Mitral most common
  • Restrictive and Insufficient
  • Restrictive stenosis
  • Insufficient regurgitation
  • Congenital-
  • Aortic tri-valve instead of bi-valve
  • Mitral valve prolapse 20 of the population
  • Men Aortic most common
  • Women Mitral most common

46
Valvular Disease
  • Restrictive- a valve that does not open
    completely and allow for emptying
  • Insufficient- a valve that does not close
    completely allowing for back flow of blood.
  • How does this effect Cardiac Output?

47
Evaluation of Goals
  • How do you do that?
  • Look to measurable goals.
  • Was it realistic?
  • Did it happen? Why or why not?
  • Make new goals
  • Reevaluate

48
Evaluation of Medications
  • How do you know if it is working?
  • Remember to make measurable goals.
  • Documentation is important.
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