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Study Guide: Oxygenation and Tissue Perfusion
1. Signs and Symptoms of Cardiac Conditions:
• Coronary Artery Disease (CAD):
o Results from the narrowing of the arteries by atherosclerosis, spasms, or
congenital malformations.
o Associated with obesity, diabetes, and high cholesterol levels.
• Atherosclerosis:
o A condition where arteries narrow.
o Primarily associated with high total cholesterol levels, specifically above 200
mg/dL, which is considered a risk factor.
• Myocardial Infarction (MI) / Heart Attack:
o Occurs when blood clot formation or plaque buildup totally blocks blood flow
to a portion of the myocardium (heart muscle).
o Clinical Manifestations:
▪ Pain or discomfort between the neck and navel.
▪ Associated dyspnea (shortness of breath).
▪ Diaphoresis (sweating).
▪ Nausea and vomiting.
o In Women, signs and symptoms may vary and include:
▪ Pain or pressure in the chest, back, neck, jaw, stomach, or one or both
arms.
▪ Shortness of breath.
▪ Nausea or vomiting.
▪ Lightheadedness.
▪ Breaking out in a cold sweat.
• Stroke (Cerebrovascular Accident):
o caused by a blood clot dislodging from the left atrium and entering the
cerebral circulation, particularly in patients with cardiac arrhythmias like atrial
fibrillation.
• Congestive Heart Failure (CHF) / Cardiac Failure:
o Characterized by decreased contractility, impaired systolic function, ventricular
dilation, and a reduced ability of the heart to meet the body's tissue needs.
o The ejection fraction is reduced.
o Symptoms warranting a call to the primary care provider (PCP) include:
▪ Shortness of breath with exertion or when supine.
▪ Weight gain of 2 to 3 pounds in 1 day or 5 pounds in 1 week.
▪ Increased cough with pink-tinged sputum.
, ▪ New or increased swelling of the ankles, feet, or abdomen.
o Contributing factors include damage to a heart valve, pressure around the heart,
deficiency of B vitamins, and damage to blood vessels. Hypertension and obesity
can also contribute to heart failure.
2. Nursing Care, Interventions, Implementation, and Outcomes for Cardiac Diseases:
, • General Nursing Care & Collaboration:
o Coordination of care for patients with oxygenation problems involves
interprofessional collaboration among nurses, physicians, respiratory therapists,
speech therapists, and physical therapists.
o The care plan is based on the PCP's physical examination and is modified based
on nursing assessments, including vital signs and ongoing cardiac and
pulmonary assessments.
o Evaluation of the patient's treatment regimen is an ongoing part of the nursing
process.
o Frequent reevaluation of vital signs with pulse oximetry, weight, activity
tolerance, intake and output, and laboratory values is necessary to evaluate goal
attainment.
• Medications:
o Hypertension may be treated with diuretics, angiotensin-converting enzyme
(ACE) inhibitors, angiotensin II receptor antagonists, beta-blockers, calcium
channel blockers, alpha-1 antagonists, alpha-2 agonists, and vasodilators.
o Nurses should monitor the patient's blood pressure and be alert for adverse
reactions like dizziness and hypotension.
o Diuretics may be given for heart failure or edema; appropriate nursing measures
include monitoring daily weights and intake and output.
o Antiarrhythmics may be used for patients with arrhythmias or heart failure to
slow the heart rate and increase cardiac output.
o Bronchodilators
• Anticoagulant Therapy:
o Used in patients with cardiac arrhythmias (e.g., atrial fibrillation) to prevent
blood clot formation (e.g., to prevent stroke).
o Also used to prevent venous thromboembolism (VTE) in acutely ill patients.
o Medications include warfarin, unfractionated heparin, low-molecular-weight
heparins, direct factor Xa inhibitors (rivaroxaban, apixaban), and direct thrombin
inhibitors (dabigatran). Novel oral anticoagulants (NOACs) have fewer food/drug
interactions, don't require routine lab checks, and have a quick onset, but
generally lack reversal agents (except dabigatran).
o Safe Practice Alert: Patients on anticoagulation therapy need to be monitored
carefully for signs and symptoms of bleeding, including heart rate, blood
pressure, mental status changes, increased bruising, or bleeding of mucous
membranes.
o Patient Education for anticoagulation therapy is crucial and includes: importance
of following prescribed regimen, dietary advice (controlling foods high in vitamin
K for warfarin), signs of adverse reactions (bleeding), and interactions with other
medications.
• Antiembolism Hose and Sequential Compression Devices (SCDs):
o Antiembolism hose are tight, elastic stockings used to promote venous blood
return and prevent edema in lower extremities, DVT, venous stasis, and
pulmonary embolism (PE).
o SCDs are inflatable sleeves wrapped around legs of immobile patients at risk for
lower extremity venous stasis.