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Download Cardiovascular and Peripheral Vascular Disorders (Heart)
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NURSING OF ADULTS WITH MEDICAL & SURGICAL CONDITIONS Diseases and Disorders of the Heart Angina Pectoris • Etiology/Pathophysiology – Cardiac muscle is deprived of oxygen • Ischemia – Increased workload on the heart • • • • • Exposure to cold Exercise Unusually heavy meals Emotional stress Other strenuous activity Angina Pectoris • Signs & Symptoms – Pain (usually relieved by rest) • heaviness or tightness in chest • usually substernal or retrosternal • may radiate – – – – – Dyspnea Anxiety Apprehension Diaphoresis Nausea Ischemic Myocardial Pain Angina Pectoris • Treatment – Correct cardiovascular risk factors – Avoid precipitating factors – Medications • dilate coronary arteries and decrease workload of heart • Nitroglycerin – give SL, repeat q 5 min, up to three times • Beta adrenergic blocking agents – Inderal, Corgard, Lopressor • Calcium channel blockers – Procardia, Cardizem, Calan, Isoptin Angina Pectoris • Surgical Interventions – Coronary Artery Bypass Graft (CABG) • Saphenous vein used to bypass occluded arteries – Percutaneous Transluminal Coronary Angioplasty (PTCA) • Cardiac catheterization is done and a balloon inflated in narrowed artery – Stent Placement • Expandable, meshlike structures designed • to maintain vessel patency Coronary Artery Bypass Graft PTCA & Stent Myocardial Infarction • Etiology/Pathophyisiolgy – Occlusion of a major coronary artery or one of its branches with subsequent necrosis of myocardium • Most common cause is atherosclerosis – Ability of the cardiac muscle to contract and pump blood is impaired Common Locations of MI Myocardial Infarction • Signs & Symptoms – – – – – – – – – – Asymptomatic (silent MI) Similar to Angina Pectoris, but are more severe and last longer Pain (not relieved by rest, position, or nitroglycerine) Nausea SOB Dizziness Weakness Diaphoresis Pallor - ashen color Sense of impending doom Myocardial Infarction • Treatment – Oxygen – Fibrinolytic agents • Streptokinase • Tissue plasma activator (TPA) – Percutaneous Transluminal Coronary Angioplasty (PTCA) – Coronary Artery Bypass Graft surgery – Medications Myocardial Infarction Congestive Heart Failure • Etiology/Pathophysiology – Abnormal condition characterized by circulatory congestion as a result of the heart’s inability to act as an effective pump. – Left ventricular failure • Most common – Right ventricular failure • Usually caused by left ventricular failure Congestive Heart Failure • Signs & Symptoms – Decreased cardiac output • • • • • • • • fatigue angina anxiety oliguria decreased GI motility pale, cool skin weight gain restlessness Congestive Heart Failure – Left Ventricular Failure • Pulmonary congestion – – – – – – – dyspnea paroxysmal nocturnal dyspnea cough frothy, blood-tinged sputum orthopnea pulmonary crackles pleural effusion (x-ray) Congestive Heart Failure – Right Ventricular Failure • • • • • Distended jugular veins Anorexia, nausea, and abdominal distention Liver enlargement Ascites Edema in feet, ankles, sacrum; may progress up the legs into thighs, external genitalia, and lower trunk Congestive Heart Failure • Treatment – Increase cardiac efficiency • Digitalis • Vasodilators – nitroglycerin • ACE inhibitors (decrease B/P) – Capoten, Vasotec, Altace, Lotnesin, Prinivil, Zestril, Accupril Monopril – Lower oxygen requirements – Bedrest, HOB elevated – Oxygen Congestive Heart Failure – Treat edema and pulmonary congestion – diuretics – sodium restricted diet – restriction of fluids – Monitor fluid retention – weigh daily – strict I&O Pulmonary Edema • Etiology/Pathophysiology – Accumulation of fluid in lung tissues and alveoli – Complication of CHF Pulmonary Edema • Signs & Symptoms – – – – – – – – – – Restlessness Agitation Disorientation Diaphoresis Dyspnea & Tachypnea Tachycardia Pallor or cyanosis Cough - large amounts of blood-tinged, frothy sputum Wheezing, crackles Cold extremities Pulmonary Edema • Treatment – – – – – High Fowler’s or Orthop. postion Morphine sulfate Oxygen Nitroglycerin Diuretics • Lasix, Bumex – Inotropic agents (increase myocard. Contraction & periph. dilation) • Dobutrex, Inocor – Vasodilators • Nitropress Valvular Heart Disease • Etiology/Pathophysiology – Heart valves are compromised and do not open and close properly • Stenosis – thickening of the valve tissue, causing the balve to become narrow • Insufficiency – valve is unable to close completely – Congenital – Rheumatic fever Valvular Heart Disease • Signs & Symptoms – – – – – – – – Fatigue Angina Oliguria Pale, cool skin Weight gain Restlessness Abnormal breath sounds Edema Valvular Heart Disease • Treatment – – – – – Restrict activities Sodium restricted diet Diuretics Digoxin Antidysrhythmics • Pronestyl, Quinidine, Lidocaine, Norpace – Surgery • Open mitral commissurotomy – splitting of the fused valve • Valve replacement – valve replaced with a bioprosthetic or mechanical valve Rheumatic Heart Disease • Etiology/Pathophysiology – Rheumatic Fever • inflammatory disease which is a delayed childhood reaction to inadequately treated childhood upper resp. tract infection of Beta hemolytic streptococci • causes scar tissue in the heart Rheumatic Heart Disease • Signs & Symptoms – – – – – – – – Elevated temperature Elevated heart rate Epistaxis Anemia Joint pain and stiffness Nodules on the joints Specific to valve affected Heart murmur Rheumatic Heart Disease • Treatment – Prevention • Treat infections rapidly and completely – Penicillin – – – – – – Bedrest NSAID’s Application of heat Well-balanced diet (supplement with Vit. B & C) Encourage fluids Commissurotomy or valve replacement Pericarditis • Etiology/Pathophysiology – Inflammation of the membranous sac surrounding the heart – May be acute or chronic – Bacterial, viral, or fungal – Noninfectious conditions • azotemia, MI, neoplasms, scleroderma, trauma, SLE, radiation, drugs Pericarditis • Signs & Symptoms – Debilitating pain • aggravated by lying supine, deep breathing, coughing, swallowing and moving the trunk – – – – – – – Dyspnea Fever Chills Diaphoresis Leukocytosis Pericardial friction rub Pericardial effusion (x-ray) Pericarditis • Treatment – Analgesia • morphine, Demerol – – – – – Oxygen IV fluids Salicylates Antibiotics Antiinflammatory agents • Indocin – Corticosteroids – Surgery • Pericardial window, pericardial tap Endocarditis • Etiology/pathophysiolgy – Infection or inflammation of the inner membranous lining of the heart – Risk factors • • • • • rheumatic heart disease CHF Degenerative heart disease Invasive procedures “mainline” drug users Endocarditis • Signs & Symptoms – Influenza-like symptoms • • • • • • – – – – – Fever Fatigue Chest pain Headaches Joint pain Chills Petechiae in the conjunctiva, mouth, and legs Anemia Splinter hemorrhages under nails Weight loss Heart murmur Endocarditis • Treatment – Bedrest – Antibiotics • IV 1-2 months – Prophylactic antibiotics for “high risk” patients – Surgical repair of diseased valves or valve replacement Myocarditis • Etiology/Pathophysiology – – – – – Inflammation of the myocardium Rheumatic heart disease Viral, bacterial, or fungal infection Endocarditis Pericarditis Myocarditis • Signs & Symptoms – – – – – Vary according to site of infection Cardiac enlargement Murmur Gallop Tachycardia Myocarditis • Treatment – – – – – Bedrest Oxygen Antibiotics Antiinflammatory agents Assessment and correction of dysrhythmias Cardiomyopathy • Etiology/Pathophysiology – A group of heart muscle diseases that primarily affects the structural or functional ability of the myocardium – Not associated with CAD, hypertension, vascular disease, or pulmonary disease – Primary - unknown cause – Secondary - Infective, metabolic, nutritional, alcohol, peripartum, drugs, radiation, SLE, rheumatoid arthritis Cardiomyopathy • Signs & Symptoms – – – – – – Angina Syncope Fatigue Dyspnea on exertion Severe exercise intolerance S/S of left and right-sided CHF • dyspnea, peripheral edema, ascites, hepatic dysfunction Cardiomyopathy • Treatment – – – – – – Treat underlying cause Diuretics ACE inhibitors Beta-adrenergic blocking agents Internal defibrillator Cardiac transplant