UPNS 23 Exam 3 Review Notes

Chapter 35: Care of Patient with Cardiac Problems
 Right atrium  tricuspid valve  right ventricle  pulmonic valve  pulmonary artery
 lungs  pulmonary veins  left atrium  mitral valve  left ventricle  aortic
valve  aorta
o NEED TO KNOW***
 High pressure on aortic valve, left ventricle has to work harder; sometimes muscle will
get weak and can’t overcome
 If I have not a lot of pressure on aortic valve, BP will be lower, fever will cause this, like
sitting in a hot tub for a long time, LOW BP
 If patient with hypertension, pressure that the LV has to overcome is greater
 Preload: volume that heart has to work with
o Increase amount of volume: IV fluids (bolus), blood products, thirst, renal
failure/HF, sodium super important in heart failure****
o Decrease: diuretic, trauma, urine output, burns
 Afterload: what aortic valve has to pump out against; pressure body has to overcome
o Things that constrict vessels; smoking, albuterol (increase fight or flight),
hyperlipidemia (plaque)
o Things that dilate vessels: sepsis, fever (drops BP), nitrates (give this for MI to
relax blood flow to heart bc constricted), digoxin inotrope (help with pump)
 PRELOAD AND AFTERLOAD ARE VERY IMPORTANT
o Things that increase afterload
 Hypertension
 Cardiac output: amount of blood pumped from ventricles
o SV x HR = CO
o If patient is super volume depleted and give fluids, HR comes down
o HR is compensatory response
o If patient has HR of 40, increase or hold on to volume
 Stroke volume: volume with each contraction of the heart
 If ventricles are unable to fill, this is a problem with preload
 Cardiac output affects renal output
o Kidneys are very sensitive to perfusion
o Decreased cardiac output, decreased kidney filtration
 Left sided heart is what is more severe
 Take Lasix, diuretic affects preload
 CHF patient will often have bad period and then improve and so on
 Ejection fraction: percentage of blood in ventricles that is ejected during systole
o If ejection fraction is 75%, that is the blood pumped out with 75% of what is
given
o If I have ejection of 15%, heart is only able to pump out 15% of what it is given;
BAD
 During diastole, mitral valves open
 Systole, they close

,  Heart failure
o Heart dysfunction that results in inadequate perfusion of tissues with blood
borne nutrients
o Think of this as pump failure
o If patient has acute MI or heart attack, they are going to have an acutely weak
heart
 Thinned out muscle and increased capacity to hold volume
 If I have more volume (body is trying to hold onto volume), the contractibility is not
there
 Heart failure: heart has more room to take blood in but can’t get it out as efficiently
 Can also have thickening of muscle, but preload is reduced
 Diabetes will help deposit lipids, heart has to work harder to get rid of
 75% of the time when heart failure occurs, hypertension is the cause
 Acute: from MI
 Chronic: progressive deterioration of muscle
 Pregnancy can put person into HF
 Acute: from MI or injury
 Chronic: progressive deterioration of heart muscle
 PND
o The fluid from throughout the day, person lays down and volume is redistributed
and absorbed, person wakes up feeling SOB and restless
 First sign someone is struggling with CHF
 Systolic failure
o Weak pump
 Diastolic failure
o Stiff ventricle
 left sided failure can back up into right
 left sided heart failure (LUNGS)
o main pumping ventricle
o decreased blood through body
o backed up into lungs
o patient will complain of: SOB, auscultate crackles, sputum, weakness/fatigue,
pink frothy sputum (pulmonary edema), cough that gets worse at night (laying
down gets backed up in lungs)
o oliguria
 LESS THAN 30 CC/HOUR
o If heart is not pumping well, kidney will not function well
o URINE OUPUT IS DIRECTLY RELATED TO CARDIAC OUTPUT***
o Manifestations
 Cough
 Fatigue
 Orthopnea
 Cyanosis