Enter Category Name
Symptoms of CAD
Chest discomfort, chest pain (angina), dyspnea, palpitations or tachycardia, N&V, weakness,
Box 20.1 pg. 464
Contributing factors of CAD
over 40 years of age, use of contraceptive use, familial history, smoking, DM, HTN, HLD, sedimentary lifestyle
Progression of atherosclerosis
plaque accumulates and becomes fibrotic from inflammation then further narrowing occurs and eventually an obstruction (thrombis) occurs blocking causing muscle damage and angina... once oxygen is restricted you get ischemia/infarct... MI
Best way to monitor perfusion after any cardiac related procedures/surgery?
I & O's...monitor urine output... atleast 30mL/hr
Angina
Heaviness in chest
Pain radiates to neck/jaw
lasts a few minutes
Triggers- exertion, stress, extreme temperatures
Relieved with rest and Nitro
Heart Attack (MI)
Deep pain in chest with "squeezing"
Pain radiates to neck/jaw
lasts longer than 30 min.
No triggers
Very little to no relief with rest or Nitro
S/S of MI
Chest pain, SOB, N&V, tachycardia, sweating, weakness, fatigue, indigestion, pale, cool, clammy skin
What is an ejection fraction? And what is the normal?
Amount of blood ejected from left ventricle
50-70%
MI Treatment?
Oxygen, Nitro, Morphine, Aspirin
ZStable angina
AKA "exertional" bc it is predictable. We predict the pain will occur with exertion, exercise or stress.
Relieved with rest
Unstable angina
Chest pain that occurs at rest with no exertion or stress.
Is not relieved with rest.
Oxygen & Nitro
Nitroglycerin Pt teaching
Sublingual every 5 min x3. If chest pain unrelieved after third dose call 911. May cause headache. Sit or lie down when taking medication to prevent fall from dizziness or drop in blood pressure. Mediation should be kept in original dark bottle and replaced every 6 months.
Troponin
<0.035
Postop care Coronary Artery Bypass Graft
Assess chest incision and graft harvest site.
Assess peripheral pluses
Watch for S/S of internal bleeding
Monitor urine output
No pushing, pulling, lifting
Splint incision with coughing.
Control BS, eat healthy
Use incentive spirometer
Up in chair and ambulate
Care post stent placement
check distal pulses
ensure pressure
monitor vital signs
watch for bleeding
Antiplatelet
Causes of Heart Failure
Coronary artery disease (MI), drugs, infections, valve disorders, pulmonary diseases, uncontrolled hypertension, anemia, pregnancy
Right heart failure
Edema in legs, ascites, JVD, enlarged liver, fatigue, weight gain, dyspnea
Doppler Ultrasound
looks for clots in carotids, arms, legs
Echocardiogram
Looks at heart size, shape, and position of structures and movement within the heart
determines ejection fraction of the left ventricle
Exercise stress test
Chemical stress test
Electrodes are placed on chest- monitor heart rhythm and rate while walking on a treadmill
Chemical uses adenosine to "stress" the heart.
Both monitor for increased oxygen demand and indicate possible ischemia. Avoid caffeine/stimulants before
Left-sided heart failure
fatigue, crackles, orthopnea, pallor, clammy skin, pulmonary edema (pink frothy sputum)
Pericarditis
inflammation of the sac around the heart
can cause cardiac tamponade- EMERGENCY
Will hear friction rub when auscultating
Need pericardiocentesis (by physician)
Valve disorders
Dyspnea, chest pain, weakness, fatigue
If hear extra sounds during assessment need to notify someome or check chart to see if normal for patient.
Valve replacement-
mechanical -mental need antiplatelet after
Prophylactic abx before dental procedures
Cardioversion
Conscious
Can sign Consent
Aflutter or Vtach with pulse
Cardiac catherization, Coronary angiogram
Assess patency of coronary arteries/blockages.
Radial or femoral artery access
Consent, mild sedation, contrast medium
May place balloon or stent to open artery
Needs pressure- monitor for bleeding
If femoral- bedrest-dont move leg
HOB 30 degrees