Summary Medsurg cardiac meds, CAD, angina (part1)

Med Surg- Cardiac (part 1) Systemic Transport: Process of providing enough blood, oxygen, and nutrients to the cells of the body. -Heart begins to beat at 8 weeks gestation -Our heart needs 70-80% of Oxygen and is perfused during Diastole (resting period) *Our Heart Needs: Adequate Cardiac Pump, Satisfactory and Passable Vasculature, Sufficient Blood Supply* Blood Flow Recap: De-oxygenated blood enters the Right Atrium coming from the body via superior and inferior vena cava, passes the Tricuspid Valve into the Right Ventricle. . Out to Pulmonary Artery which carries the deoxygenated blood into the lungs. . Oxygenated blood comes back to the heart through the Pulmonary Veins into the Left Atrium – through Bicuspid/Mitral Valve, into the Left Ventricle and out the Ascending & Descending Aorta to supply the rest of the body. Definitions Hypoxemia: low O2 in blood / Acidosis: Occurs from low contractility of the heart Cardiac Output = Stroke Volume X Heart Rate (the volume of blood ejected from the ventricle in one minute) Normal cardiac output is usually 4-8L/Min. -reduced cardiac output can be caused by MI, heart failure due to hypertension, heart diseases, arrythmias, pulmonary disease, fluid overload, decreased fluid volume, electrolyte imbalances, or medication effects. -Signs of decreased cardiac output: tachycardia, tachypnea, decreased peripheral pulses, cool skin, angina, exercise intolerance, decreased urine output, volume overload, lung crackles, orthopnea, pedal edema, hypotension. Stroke Volume: Amount of blood ejected per heartbeat ; 60-130 is average *SV is determined by Pre-load and After-load Pre-load: the Stretch of the muscle fibers at the end of diastole -Diastole: heart is resting while the chambers fill After-load: the pressure that the ventricles must overcome in order to be able to eject blood out of the heart during systole ( Ejection: Right ventricle pumping to Pulmonary artery & the Left Ventricle pumping to Aorta) -Systole: contraction of the heart / how hard they “squeeze” -Increased Contractility = Increased Stroke Volume (SV) -Contraction = Our pulse that we record What Decreases Pre-load? Diuretics, Vasodilators, Hemorrhage What Increases Pre-load? IV Fluids, Blood transfusion, Overhydration Vasoconstriction: narrowing of blood vessels (SNS: increases HR, Increases BP) Vasodilation: opening of a blood vessel (SNS blocked: decreased HR, decreases BP) *Vasodilation and Vasoconstriction are influenced by Baroreceptors Arteriosclerosis: Hardening of endothelial lining in arteries. Occurs frequently with age. (CAD) Atherosclerosis: Build-up of plaque wall by fatty lipids. – Risk of thrombus formation, traveling, causing clot, etc. **Most discussed in this lecture. (CAD) An indicator of atherosclerosis is Claudication* which is cramping in the legs induced by exercise, or excessive walking (can be intermittent) -Can begin developing in childhood -Damage to endothelium and continues to accumulate -Plaque build-up -Decreases or occludes blood flow -Decreases oxygen supply and can cause ischemia (Angina) or Necrosis (MI) -Pain in lower extremities can occur due to hardening of arteries that decrease oxygen flow to the rest of the body Atheroma: fibrous cap forming within arteries, aka plaque. Hematopoiesis: Production of blood. Occurs in bone marrow; Renal system produces erythropoietin to help with production when needed Normal HgB Men 13-17 / Women 12-15 Normal HCT Men 41-50% / Women 36-44% Normal HgbA1c between 4-5.6% / Diabetics would be 6.5% or higher Cholesterol: Fat soluble; synthesized in the liver / Normal Cholesterol total levels 200 -High Density (HDL’s) “Happy” – Protects the heart by removing lipids from the blood and transports cholesterol to liver, beneficial for our artery’s! Norms: 40 for males , 50 for women -Low Density (LDL’s) “Lousy” – transports the cholesterol to our tissues, which has a harmful effect on our artery’s! -Increased LDL levels indicate high risk of CVD, stroke, and PAD Norms: 100 ** for high Risk patients with Cardiac Issues 70. *Lipid panels are usually done around age 20- and then frequently as routine. Fasting Values patient should be NPO 8-12 hrs. before ; Glucose makes blood thicker; hyperglycemia causes injury to blood vessels in time. Complications of CAD (Atherosclerosis): Hypertension, Angina, MI, CVA, TIA, Peripheral Arterial Disease, Kidney Disease, Risk for Metabolic Syndrome -Metabolic Syndrome: other issues occur, such as hypertension, DM, altered lipid metabolism due to increased cholesterol level0073 *Patient will be diagnosed with metabolic syndrome if 2 of these factors present Risk Factors of CAD: Modifiable and Non-Modifiable Gender, Age, family history, race, exercise, hyperlipidemia, obesity, diabetes, smoking, alcohol intake, excessive salt intake in diet, women have higher complications and are at increased risk after menopause due to lower estrogen levels (they are heart protective), stress, sedentary lifestyle Manifestations of CAD: Increased HR, RR, BP – Palpitations – SOB – Dizziness due to decrease oxygen to brain -Chest pain (1st Nursing Action is to do EKG!!) – Edema (due to heart failure, seen on lower extremity) – Diaphoresis – Changes in skin color (pale-greyish) Diagnostic Tests: EKG/ECG – done within 10minutes! First Nursing Action for Chest Pain! -EKG can assess conduction, abnormality of heart, MI, SA Node malfunction and more Stress Test- either done on treadmill while attached to leads or given medication Persantine given IV to increase HR and watch on EKG. Echocardiogram- checks chambers/valves, heart rhythm using ultrasound to see how blood moves throughout the heart. Cardiac Catherization: insertion of a catheter into vein/artery from antecubital, groin or jugular access and threaded into the heart; can be diagnostic/interventional purposes; Contrast is used* requires puncturing of an artery, risk for bleeding @ the site is the first assessment* -Assesses blood flow and pressures in the heart’s valves, chambers, and arteries -Used as an alternative to open heart surgery for valvular issues or arterial occlusions Nursing Interventions Pre-Op for Cardiac Cath: NPO 8-12 hrs before, outpatient procedure unless hospitalized, contrast allergies, teach about procedure and how they might feel palpitations/asked to C&DB because this moves the contrast out of pericardial cavity