Cardiac PP spring 2010 voice overs

Chapter 26 : 

Chapter 26 Cardiac Hemodynamics

Hemodynamic monitoring : 

Hemodynamic monitoring Pulmonary artery pressure monitoring- 25/9 mm Hg Cardiac Output 4-8 L/min Central Venous Pressure Monitoring 0-8 mm Hg Pulmonary artery wedge pressure- 4.5 to 13 mm Hg

Purposes of Invasive Hemodynamic Monitoring : 

Purposes of Invasive Hemodynamic Monitoring Early detection, identification, and treatment of life-threatening conditions such as heart failure and cardiac tamponade Evaluate the patient’s immediate response to treatment such as drugs and mechanical support Evaluate the effectiveness of cardiovascular function such as cardiac output and index **Cardiac output volume of blood being ejected by the heart in a minute. Normal 4-8 L per minute. Cardiac index= cardiac output/BSA body surface area. Normal cardiac index 2.2-4Lmin

Indications for Hemodynamic Monitoring : 

Indications for Hemodynamic Monitoring Any deficit or loss of cardiac function: such as AMI, CHF, Cardiomyopathy All types of shock; cardiogenic, neurogenic,or anaphylactic Decreased urine output from dehydration, hemorrhage,G.I. bleed ,burns, or surgery

Preload : 

Preload Is the degree of muscle fiber stretching present in the ventricles right before systole Is the amount of blood in a ventricle before it contracts; also known as “filling pressures” Left ventricular preload is reflected by the PCWP. Normal WEDGE 4.5-13 mm HG Right ventricular preload is reflected by the CVP [RA]. normal CVP 0-8 mm HG -preload can be increase by fluid administration and decreased by diuresis

Afterload : 

Afterload Any resistance against which the ventricles must pump in order to eject its volume How hard the heart [either side left or right] has to push to get the blood out Also thought of as the “ resistance to flow” or how “clamped” the blood vessels are **increase afterload often results in decreased cardiac output. When afterload decrease myocardial oxygen needs are decreased.

Components of Swan-Ganz [con’t] : 

Components of Swan-Ganz [con’t] Normally has four[4] ports Proximal port – [Blue] used to measure central venous pressure/ and injectate port for measurement of cardiac output Distal port – [Yellow] used to measure pulmonary artery pressure Balloon port – [Red] used to determine pulmonary wedge pressure;1.5 special syringe is connected Infusion port – [White] used for fluid infusion

Pulmonary Artery Catheter and Pressure Monitoring System : 

Pulmonary Artery Catheter and Pressure Monitoring System

Pulmonary Artery Pressure Monitoring : 

Pulmonary Artery Pressure Monitoring Normal Pulmonary artery pressure is 25/9 with a mean pressure of 15 mm Hg

Cardiac Output/Index : 

Cardiac Output/Index Is the amount of blood ejected from the ventricle in one minute Two components multiply to make the cardiac output: heart rate and stroke volume [amount of blood ejected with each contraction] Cardiac index is the cardiac output adjusted for body surface area (BSI)

Central Venous Pressure Monitoring : 

Central Venous Pressure Monitoring CVP- pressure in the vena cava or right atrium, used to assess right ventricular function and venous return to the right side of the heart Single lumen or multilumen catheter placed into the superior vena cava Chest x-ray done to confirm placement

Central Venous Pressure (CVP) 0-8MM HG : 

Central Venous Pressure (CVP) 0-8MM HG Zero transducer to the patient’s phlebostatic axis Always read CVP at end expiration CVP is a direct measurement of right ventricular end diastolic pressure

CVP : 

CVP Increase Hypervolemia Heart failure Decrease hypovolemia

Pulmonary artery wedge pressure (PAWP) 4.5 – 13 Hg : 

Pulmonary artery wedge pressure (PAWP) 4.5 – 13 Hg An indirect measure of left arterial pressure

Possible Complications : 

Possible Complications Increased risk of infections – same as with any central venous lines—use occlusive dressing and Biopatch to prevent Thrombosis and emboli-- air embolism may occur when the balloon ruptures, clot on end of catheter can result in pulmonary embolism Catheter wedges permanently—considered an emergency, notify MD immediately, can occur when balloon is left inflated or catheter migrates too far into pulmonary artery (flat PA waveform)…can cause pulmonary infarct after only a few minutes! Ventricular irritation – occurs when catheter migrates back into RV or is looped through the ventricle, notify MD immediately…can cause VT Pneumothorax

Troubleshooting : 

Troubleshooting Dampened waveform –can occur with physical defects of the heart or catheter; can be caused by kinks, air bubbles in the system, or clots Solution: Check your line for kinks & air bubbles, aspirate (not flush) for clots, straighten out tubing or patient as much as possible No waveform – can occur with non-perfusing arrhythmias or line disconnection Solution: Check your line for disconnection, check your patient for pulse, could also be wet transducer or broken cable or box

Drugs that affect contractility : 

Drugs that affect contractility Positive Inotropes- is an agent that alters the force or energy of muscular contractions Epinephrine (adrenalin) Norepinephrine (Levophed) Isoproteronol (Isuprel Dopamine Dobutamine Primacore Digoxin

Drugs that affect contractility : 

Drugs that affect contractility Negative inotropes Barbiturates Alcohol Calcium channel blockers

WHAT IS AN ARTERIAL LINE? : 

E.Doidge.june05 WHAT IS AN ARTERIAL LINE?  An arterial catheter over a needle which is inserted into an artery using a percutaneous method, usually the radial artery Radial artery is used as it is the most accessible The axillary, femoral, brachial and pedal arteries may also be used Once inserted the catheter is attached to a pressure transducer and attached to the monitor where a continuous waveform will be seen

Arterial Line : 

Arterial Line Indications Continuous blood pressure monitoring Freqeunt blood sampling Serial arterial blood gases

Allen Test : 

Allen Test is used to test blood supply to the hand Test done to prevent compromised arterial perfusion to the area distal to the arterial catheter insertion site If no collateral circulation existed and the cannulated artery became occluded, ischemia and infarction of the area distal to that artery could occur

How to perform the Allen Test : 

How to perform the Allen Test 1) The hand is elevated and the patient/person is asked to make a fist for about 30 seconds. 2) Pressure is applied over the ulnar and the radial arteries so as to occlude both of them. 3) Still elevated, the hand is then opened. It should appear blanched (pallor can be observed at the finger nails). 4) Ulnar pressure is released and the color should return in 7 seconds. Inference: Ulnar artery supply to the hand is sufficient and it is safe to cannulate/prick the radial If color does not return or returns after 7–10 seconds, then the ulnar artery supply to the hand is not sufficient and the radial artery therefore cannot be safely pricked/cannulated.

WAVEFORMS PRODUCED BY ARTERIAL PRESSURES! : 

E.Doidge.june05 WAVEFORMS PRODUCED BY ARTERIAL PRESSURES! A normal waveform on the monitor will have a sharp upstroke, a dicrotic notch and a clear end diastole Systolic Pressure Sharp Upstroke Dicrotic Notch End Diastole Diastolic Pressure

Arterial Pressure Monitoring System : 

Arterial Pressure Monitoring System

Chapter 28 : 

Chapter 28 Management of Patients with Coronary Vascular Disorders

Coronary Artery Disease (CAD) : 

Coronary Artery Disease (CAD) Most common type of cardiovascular disease Progressive hardening and narrowing of coronary arteries caused by artheroscelerosis An abnormal accumulation of lipid, or fatty, substances and fibrous tissue in the lining of arterial blood vessel walls A major cause of heart attacks

Risk Factors CAD : 

Risk Factors CAD Increasing age  Gender Ethnicity Heredity Tobacco smoke  High blood cholesterol  High blood pressure  Obesity Diabetes mellitus

Cholesterol and CAD : 

Cholesterol and CAD HDL (high density lipoproteins)- good Contain more protein and fewer lipids Transport cholesterol away from arteries Can be raised by activity and small alcohol Can be decreased by smoking, diabetes, obesity, physical inactivity Keep > 40mg/dL

Cholesterol and CAD : 

Cholesterol and CAD LDL (low density lipoproteins)- bad Contains more lipids Transport and deposit cholesterol to the arterial walls Increases with a diet high in saturated fats Increases risk of CAD Keep< 160

Treatment : 

Treatment Low fat, low cholesterol diet Exercise Lipid lowering agents Lipitor Zocor Crestor

Chest Pain : 

Chest Pain Angina is chest pain caused by myocardial ischemia Myocardial Ischemia occurs when oxygen demand exceeds supply (usually from narrowing arteries by atherosclerosis)

Types of Angina : 

Types of Angina Stable- occurs with exertion and relieved by rest Unstable – More severe pain; May occur with exertion and at rest; may show ST depression Variant- caused by coronary artery spasms. Occurs at rest with or without precipitating factors; relieved by calcium channel blockers or nitrates; ST elevation only during episode

Clinical Manifestations of Angina : 

Clinical Manifestations of Angina Chest Discomfort Located substernally May radiate to arms usually left Jaw Neck Chest pain described as pressure, heavy, squeezing, fullness in chest, choking, or suffocation sensation Pain present, often denied, “just indigestion” Some complain of back pain or shoulder pain

Nursing Management: Angina : 

Nursing Management: Angina Aimed at maintaining cardiac output and relieving pain and anxiety Nitrates (most common)-vasodilator and decreases oxygen demand Sublingual, one tablet, wait 5 min If no relief, take 2nd tablet, wait 5 min If no relief, take 3rd tablet, wait 5 min If no relief, call MD

Nursing Management : 

Nursing Management Beta-blockers- decrease contractility, HR, and BP which reduce myocardial oxygen demand Monitor side effects, avoid in asthma patients, and don’t stop abruptly SE: hypotension, bradycardia, bronchial spams, masks hypoglycemia Ex: Lopressor (metoprolol), Inderal (propranolol), Temormin (Atenolol)

Nursing Management : 

Nursing Management Calcium-Channel Blockers-smooth muscles relaxation and vasodilation, increases coronary blood flow and perfusion, decreases contractility, decreases workload, HR, and oxygen requirements Avoid in clients with severe heart failure SE: hypotension, bradycardia, constipation, edema, AV block Ex: Procardia (nifedipine), Cardene (nicardipine), Cardizem (diltiazem)

Nursing Management : 

Nursing Management Antiplatelet medications Prevent platelet aggregation on atheroma or thrombus ASA – side effects: GI irritation, bleeding, increased bruising Plavix – side effects: increased bleeding tendencies, N/V/D, rash Integrilin – side effects: increased bleeding, nosebleeds

Nursing Management : 

Nursing Management Anticoagulants Heparin Given IV in acute situations or subcutaneous in non-acute situations Monitor partial thromboplastin time (PTT) Antidote – Protamine Sulfate Observe bleeding precautions Monitor for signs and symptoms of bleeding Half-life of 1-2 hrs Monitor for Heparin induced thrombocytopenia (HIT)

Nursing Management : 

Nursing Management Monitor EKG for changes and dysrhythmias Apply oxygen via nasal cannula Oxygen saturation should be above 93% Monitor vital signs Reduce anxiety Prepare patient for invasive interventions or surgical management Patient may need higher level of care Transfer to critical care unit

Diagnostic Tests : 

Diagnostic Tests Chest x-ray 12-lead ECG Lab tests Echocardiogram Holter monitor Exercise Stress Test Cardiac Catherization

Cardiac Catherization : 

Cardiac Catherization Invasive procedure used to confirm and evaluate the severity of lesions and fix if needed (stent, balloon) Assess LVF, measure pressures within the chambers; measures CO and EF Arteriography- visualizes blood vessels (dye) Right-femoral or brachial to right atrium, right ventricle and pulmonary artery Left-femoral, brachial, or radial through aorta to left ventricle

Pre-procedure : 

Pre-procedure Consent NPO Assess allergies No Glucophage or Metformin for 2 days before procedure Pre-medicate (Benedryl, Ativan, Mucomyst) Hydrate

Cardiac Catherization : 

Cardiac Catherization

Post-Catheterization Management : 

Post-Catheterization Management Bedrest; may be discharged in 6-8 hours Keep extremity immobile Observe site for bleeding/hematoma Maintain HOB no higher than 30 degrees Monitor peripheral pulses, color, and sensation Observe cardiac rhythm Encourage fluid intake Monitor I & O Observe for adverse reactions to dye

Myocardial Infarction : 

Myocardial Infarction Occurs as a result of sustained ischemia causing irreversible myocardial cell death Described based on location of damage (anterior, inferior, posterior) Causes: Platelet aggregation/thrombus (90%) Spasm

Clinical Manifestations : 

Clinical Manifestations Similar to unstable angina Discomfort not relieved with rest or 3 NTG Lasts longer then 20 min Diabetics (silent ischemia)- may be asymptomatic due to diabetic neuropathy affecting cardiac nerves Elderly- may be asymptomatic, may present with shortness of breath, confusion, weakness, dizziness Women- atypical discomfort; complain of fatigue, difficulty sleeping, SOB, shoulder, upper back pain

Clinical Manifestations : 

Clinical Manifestations Increased BP and HR initially due to release of catecholamines, then may drop due to decreased CO Cool clammy skin Shortness of breath Nausea/Vomiting Fever

Diagnosis of AMI : 

Diagnosis of AMI Elevated cardiac enzymes CK-MB (4-6 hrs) Troponin (3-6 hrs) Myoglobin (20-60 min) 12 lead ECG: ST elevation of ST depression

Complications of AMI : 

Complications of AMI Dysrhythmias Heart Failure Cardiogenic shock Pericarditis

Collaborative Care : 

Collaborative Care Goal: Minimize myocardial damage MONA Beta-blockers Reperfusion therapy Thrombolytic therapy within 6 hrs Dissolves clots Ex: Steptokinase, Urokinase, Activase PCI within 90 min Coronary Artery Bypass Graft (CABG)

Nursing Interventions with Thrombolytics : 

Nursing Interventions with Thrombolytics Start 2 IV lines Minimize skin punctures Avoid IM injections Monitor for signs and symptoms of bleeding Monitor for reperfusion dysrhythmias Monitor for allergic reactions Treat bleeding with direct pressure and notify doctor if severe

Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty : 

Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty Angioplasty with or without vascular stenting A guide wire is moved into and across the blockage. A balloon catheter is pushed over the guide wire and into the blockage. The balloon on the end is blown up (inflated). This opens the blocked vessel and restores proper blood flow to the heart.

Coronary Artery Stent : 

Coronary Artery Stent A stent is a small, expandable, mesh metal tube. It holds the artery open and allows the blood to flow to the heart. Once placed, a stent remains in the artery permanently. There are two kinds of heart stents: Uncoated stents –These were the first heart stents Drug-coated stents –contains sirolimus, a unique anti-rejection-type medicine. Sirolimus limits the overgrowth of cells that can cause re-blockage of the treated area in the artery (restenosis), significantly reducing the chance that you may need another procedure.

Atherectomy and Brachytherapy : 

Atherectomy and Brachytherapy ATHERECTOMY- is a procedure using a special device that removes plaque, which has built-up in the coronary artery. An atherectomy can be performed with a variety of catheter tip devices within the coronary artery to cut, have or clear an obstruction caused by plaque BRACHYTHERAPY- tiny “seeds” of radiation are placed in the coronary artery for several minutes and then removed. The seeds will decrease cell growth at the site and the risk of restenosis.

Coronary artery bypass graft surgery (CABG) : 

Coronary artery bypass graft surgery (CABG) a surgical procedure in which one or more blocked coronary arteries are bypassed by a blood vessel graft to restore normal blood flow to the heart. These grafts usually come from the patient's own arteries and veins located in the leg, arm, or chest the surgeon makes an incision down the center of the patient's chest, cuts through the breastbone, and retracts the rib cage open to expose the heart. The patient is connected to a heart-lung bypass machine, also called a cardiopulmonary bypass pump, that takes over for the heart and lungs during the surgery.

Intraaortic Balloon Pump : 

Intraaortic Balloon Pump The procedure requires placement of a catheter with an intraaortic balloon attached. The balloon is inserted into an artery, usually in the groin (the femoral artery) and then advanced into the largest artery in your body, the aorta. Next, the catheter is connected to a computer that will control the inflation/deflation, timing and pressure, so that the balloon will inflate when the heart muscle relaxes and deflate just before the heart pumps again. This process is called "counterpulsation."

Chapter 30 : 

Chapter 30 Management of Patients with complications from Heart Disease

Heart Failure : 

Heart Failure Clinical condition involving impaired cardiac pumping Cardiac output is diminished, and peripheral tissue is not adequately perfused Congestion of the lungs and periphery may occur

Heart Failure : 

Heart Failure Primary risk factors Coronary artery disease (CAD) Advancing age Contributing risk factors Hypertension Diabetes Tobacco use Obesity High serum cholesterol African American descent

Heart Failure : 

Heart Failure Hallmark finding: Decrease in the left ventricular ejection fraction (EF) Caused by Impaired contractile function (e.g., MI) Increased afterload (e.g., hypertension) Cardiomyopathy- Heart ejects less than 40% of the blood in the left ventricle (normal, 65%) reduced cardiac output leads to heart failure Mechanical abnormalities (e.g., valve disease) mitral stenosis: valvular tissue thickens and narrows the valve opening

Symptoms: Left : 

Symptoms: Left Pulmonary Crackles Cyanosis Dyspnea S3

Clinical Manifestations Of Left Ventricular Failure (LVF) : 

Clinical Manifestations Of Left Ventricular Failure (LVF) Dyspnea Dyspnea on exertion (DOE) Orthopnea Paroxysmal nocturnal dyspnea (PND) Cough Crackles Hypoxia, cyanosis Tachycardia, palpitations S3, S4, murmurs Weak, thready pulses Fatigue Pale, cool, clammy skin Restlessness, anxiety, confusion Nocturia, oliguria

Right -Sidedheart Failure : 

Right -Sidedheart Failure Right ventricular failure usually follows left ventricular failure Right ventricular failure can occur solely without left ventricular failure – cor pulmonale Heart failure can affect systolic function or diastolic function

Clinical Manifestations of Right Ventricular Failure (RVF) : 

Clinical Manifestations of Right Ventricular Failure (RVF) Elevated JVD Hepatomegaly, splenomegaly Ascites Anorexia, nausea, constipation Sacral edema Peripheral edema Anasarca Weight gain Decreased activity tolerance

Diagnostic Studies : 

Diagnostic Studies Primary goal is to determine underlying cause History and physical examination Chest x-ray ECG Lab studies (e.g., cardiac enzymes, BNP) Echocardiogram

BNP : 

BNP Measures the amount of the BNP hormone inn your blood. BNP is made by your heart and indicates how well your heart is working. Normally, only a low amount of BNP is found in your blood. However, if your heart has to work harder than usual over a long period of time, such as from heart failure, the heart releases more BNP, increasing the blood level of BNP. The BNP level will drop when treatment for heart failure is working.

Treatment : 

Treatment Diuretics ACE Inhibitors/ ARB Beta-blockers Nitrates Digoxin Primacore

HF Management : 

HF Management Diet: low salt Exercise Daily weight Weight gain of 3 lb (1.4 kg) over 2 days or a 3- to 5-lb (2.3 kg) gain over a week should be reported to health care provider Diuretic regulations

Pharmacologic Management of Heart Failure : 

Pharmacologic Management of Heart Failure ACE inhibitors Vasodilate Promote diuresis Drugs – Vasotec, Captopril, Zestril, Angiotensin II Receptor Blockers (ARBs) Prescribed when patient intolerant of ACE-I Drugs – Diovan, Aticand

Beta Blockers : 

Beta Blockers Beta1 Blockers Decrease cytotoxic effects of constant stimulation of SNS Decrease workload by decreasing heart rate Drugs - Coreg, Lopressor, Atenolol

Diuretics : 

Diuretics Diuretics Control Na and H2O retention Three types Potassium sparing –Aldactone (spironalactone), Inspra (eplerenone) Loop diuretics – Lasix (furosemide) Thiazide diuretics – Zaroxolyn (metolazone), HCTZ (hydrochlorazide) Monitor for hypotension, lyte imbalances and dehydration, worsening renal fa

Cardiac glycosides : 

Cardiac glycosides Cardiac glycosides Increase force of myocardial contraction and slow conduction through AV node Drugs – Lanoxin (digoxin), Primacor, Inocor Precautions with Lanoxin administration Decreased renal function slows elimination Will need to decrease dose with certain meds ie. amiodarone, erythromycin, quinidine Usual dose – 0.125 mg to 0.5 mg (PO,IV,IM)

Slide 76: 

Lanoxin toxicity – Therapeutic level 0.5-2.0 ng/mL Symptoms – anorexia, N/V, fatigue, H/A, yellow or green halos, new dysrhythmias Reversal – hold dose or administer Digibind (digoxin immune FAB) Nursing considerations for Lanoxin administration Assess heart rate for 1 min Give after breakfast Monitor for hypokalemia

CCB : 

CCB Calcium channel blockers Contraindicated with severe systolic dysfunction Drugs – Norvasc, Cardizem, Procardia

Natrecor : 

Natrecor Natrecor (nesiritide) Indicated for the IV treatment of clients with acutely decompensated congestive heart failure with dyspnea at rest Manufactured from E-coli Effects - dilates veins and arteries, suppresses Aldosterone Administration - IV bolus, then drip for 48 hrs Contraindications - systolic pressure <90mm Hg, binds with Heparin Side effects - hypotension, VT, HA, nausea Incompatible with Heparin in same line

Chapter 29 : 

Chapter 29 Infectious Diseases of the Heart

Infectious Diseases of the Heart : 

Infectious Diseases of the Heart Any of the layers of the heart may be affected by an infectious process. Diseases are named by the layer of the heart that is affected. Diagnosis is made by patient symptoms and echocardiogram. Blood cultures may be used to identify the infectious agent and to monitor therapy. Treatment is with appropriate antimicrobial therapy. Patients need to be instructed to complete the course of appropriate antimicrobial therapy, and require teaching about infection prevention and health promotion.

Rheumatic Endocarditis : 

Rheumatic Endocarditis Occurs most often in school-age children, after group A beta-hemolytic streptococcal pharyngitis Injury to heart tissue is caused by inflammatory or sensitivity reaction to the streptococci. Myocardial and pericardial tissue is also affected, but endocarditis results in permanent changes in the valves. Need to promptly recognize and treat “strep” throat to prevent rheumatic fever. See Chart 29-1.

Infective Endocarditis : 

Infective Endocarditis Infection of microorganisms circulating in the bloodstream that attach onto endocardial surface. Organisms can enter blood stream variety of ways including during surgical procedures or dental procedures. Patients with history of valve disease prophylaxtic antibiotic before and after dental procedure Usually caused by Step or Staph-rheumatic endocarditis with strep thoart Vegetations form on heart valves-right pulmonary embolic. Left systemic emboli Fatal if not treated Usually seen in patients with prosthetic heart valves, more common elderly/immunocompromised and patient with heart defects and iv drug users

Infective Endocarditis- platlets/bloods cells accumulate have vegetation on the heart valves : 

Infective Endocarditis- platlets/bloods cells accumulate have vegetation on the heart valves Clinical Manifestations Fever, chills Night sweats Cough, weight loss Weakness, fatigue New murmur Positive blood culture Janeway lesions-red spots, palm hands and soles of feet Osler nodes- painful sores tips of fingers and toes Splinter hemorrhages- dark lines under finger nales

Infective Endocarditis : 

Infective Endocarditis Diagnosis: Echocardiogram- TEE will show vegatation on the valves. Elevated ESR (erthrocyte sedmintation rate (inflammation) Treatment: Antibiotics, rest. Iv antibiotics 2-6 weeks home antibiotics, PICC line, central line home health nurse PCN, VANC, GENT p and t. Fungal amphotericin B Prevention: Antibiotic prescription before treatments

Myocarditis : 

Myocarditis An inflammation of the myocardium-- muscle layer surrounding the heart A viral, bacterial, fungal or parasitic infection causes. Myocardium can become inflamed from the toxins of microorganisms, chronic alcohol abuse, radiation therapy or autoimmune disorders

Clinical Manifestations : 

1 Clinical Manifestations Most cases of acute myocarditis are clinically silent flulike symptoms Large number identified by heart failure symptoms some pts with myocarditis and HF have chest pain May mimic an acute MI, ischemic chest pain,

Pericarditis : 

Pericarditis Inflammation of the pericardium sac which surrounds the heart Fluid accumulates in the pericardium Manifestations: Sharp chest pain over the sternum, radiating to the back, neck, shoulders and arms Pain increases with deep inspiration May be relieved by sitting up Friction rub (grating, scratching sound) Shortness of breath Weakness, fatigue Pulsus paradoxum

Pericarditis : 

Pericarditis Causes: Bacterial, fungal, or viral Neoplasms form lungs, breasts or other organs Autoimmune diseases (lupus, RA) Post cardiac injury Medications Aortic aneurysm leakage Post Mi (Dressler's syndrome)

Pericarditis : 

Pericarditis Diagnosis: Echocardiogram, WBC, ESR (indicative of inflammation/infection) Treatment: pain relief (anti-inflammatories), pericardiocentesis. Steroids, anagesics, diuretics

Pericarditis, cont : 

Pericarditis, cont Nursing interventions Assess pain and give RX HOB elevated for dyspnea Bedrest to decrease workload of the heart O2 as ordered Monitor Vitals including CVP May need pericardial window and then follow routine post op care

Cardiac Tamponade : 

Cardiac Tamponade Cardiac tamponade is the compression of the heart that occurs when blood or fluid builds up in the space between the myocardium (the muscle of the heart) and the pericardium (the outer covering sac of the heart). Treatment usually involves a procedure to drain the fluid around the heart (pericardiocentesis) or to cut and remove part of the pericardium (surgical pericardiectomy or pericardial window).

Cardiac Tamponade : 

Cardiac Tamponade Classic signs are: BECK’s Triad: muffled or distant heart sounds, hypotension, elevated venous pressure…and may not present until the patient is hypovolemic and hypotensive. Pulsus paradoxus= a decrease in systolic blood pressure during spontaneous respiration.

Chapter 31 : 

Chapter 31 Dissecting Aorta

Abdominal Aortic Aneurysm : 

Abdominal Aortic Aneurysm

Slide 95: 

Most aortas less than 5cm in diameter do not rupture Men affected 4x more 2x more common in whites Incidence increase with age

Pathophysiology AAA : 

Pathophysiology AAA Congenital weakness Trauma Genetic Predisposition Tobacco Hypertension

Aortic Dissection : 

Aortic Dissection May be caused by a sudden tear in the aortic intima, opening the way for blood to enter the aortic wall Severe Abdominal or back pain- described as tearing, ripping, and stabbing (Continued)

Aortic Dissection (Continued) : 

Aortic Dissection (Continued) Emergency care goals include: Elimination of pain Reduction of blood pressure Decrease in the velocity of left ventricular ejection Nonsurgical treatment Surgical treatment

AAA- Nursing management : 

AAA- Nursing management