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Right-sided Heart Failure
- Etiology: pulmonayr stenosis, pulmonary hypertension, Sever emphysema
- Pathophysiology: myocardium of the rt atrium and ventricle becomes thickened, and contraction strength is reduced
- S/S: Fatigue, edema in sacrum, legs, feet, ankles. Hepatomegaly, Abdominal distention as a result of ascites, weight gain, dyspnia
Left-sided Heart Failure
- Etiology: Coronary artery disease, MI, valvular disease.
- Pathophysiology: Weakness of the left ventricle resulting in reduced cardiac output and backup of fluid in teh pulmonary system.
- S/S: Fatigue, dyspnea, wheezing, orthopnea, sleep apnea, pulmonary edema (pink, frothy sputum) Pallor, clammy skin.
Heart Failure Intervention
- Limited physical activity or bed rest in semifowler's or high fowler's position
- Reduction of emotional stress
- Oxygen therapy
- Beta-adrenergic blockers to slow h/r if tachycardia is causing HF
- ACE inhibitors to decreas work load
- Benous Vasodilators
- Morphine for pulmonary edema to relieve anxiety and make breathing easier
- Lifestyle modifications, fluid restrictions, limited sodium
- Promote Rest/alternate activites
- *small frequent meals
Pulmonary Edema - complication of HF (medical emergance that must be treated promptly)
- Severe Dyspnea (shortness of breath)
- productive couch (pink, frothy sputum)
- Tachycardia (fast heart rate)
- Moist bubbling respirations with cyanosis
Morphine for Heart Failure/chest pian
- Slow work load
- reduces air hunger
- relieves anexiey
- relieves pain
- (easy breathing)
- Use: short-term treatment of CHF
- Action: Peripheral vasodilation that reduces preload and afterload
- Nursing implications: monitor for hypotension; watch hydration status; assess lungs for decreasing crackles in bases; may increase platelet count
Acute Pulmonary edema - sudden onset
- high fowlers
What causes pain in coronary artery disease
Ischemia (a defieciency of blood supply to a part as a result of functional contriciton of a blood vessel or of acutal obstruction, as by clot)
What Happens in MI (Myocardial Infarction)
Etiology: thrombosis due to atherosclerosis, emoblus from somewhere else blocls a coronary artery, or sustained arterial spasm in a coronary artey
Blood flow is stopped to a portion of the myocardiam
- Myocardial: pertaining to the heart muscle
- Infarction: is an area of necrosis in tissue caused by an obstruction to the flow of blood for a prolonged period
- Diagnosis: EKG, telemonitor, blood test CPK-MB
- troponin t - elevated
- Intervetions: monitor, decrease anexiety, promote rest, educaton, I & O, maintain IV site.
What is arythemia
abnormal heart beat
treatment for arythemia
- reduce caffeine
- warn about hidden caffeine and withdrawl
- Use: to prevent clotting and emboli formation
- Nursing Implications: observe for signs of abnormal bleed by checking vitals, monitor urine and stool for signs of internal bleeding; inspect skin for bruises and petechiae; ask about bleeding gums with toothbrushing
- Patient teaching: explain rational for med. explain hazards of hemorrage, reason for frequent blood tests, safety precausions and foods that affect clotting, over the counter meds - warn do not take asprin or other salicylates.
Low fat / Low choleserol diet
- Limit meat - use lean meat
- five to seven servings of fruit and vegies
- increase fiber, carbs, whole-grain products
- use skim or 1% milk, low fat cheese and yogurt
- avoid trans fat
- cook using little or no fat, broil, bake, roast, poach
- limit egg yolks
- less salt
- limit alcohol
Heart disease in women
- subtle signs
- may not experience typical symptoms
- Purpose: determine areas of narrowing or structural changes, such as an aneurysm in an artery. Detect the presence of an embolus
- Procedure: catheter is threaded into an artery and a radiopaque dy is injected, radigraphs are take. Postop care includes monitor for bleeding for cath inscision site, neurologic signs, vitals often to check for embolus or bleeding
Diabetics have increased risk for heart disease.
- tight management of glucose
- Keep blood sugar levels under control
- below 110
- Etiology: atherosclerosis, hypertension, heart disease, family history, smoking, imporper diet
- S/S: Pulses: diminished, weak, or absent.
- Skin: Pallor, dependent rubor, thin, dry, shiny, cool
- Edema: absent or mild
- Ulceration: likely on toes or at pressure points
- Pain: intermitten claudication when walking; sharp, stabbing, gnawing - less at rest
- Nails: thick and brittle
- Hair: loss distal to are of occlusion
- Etiology: unknown, contributing factors: obesity, family or personal history of artherosclerosis, trauma, hypertension, smoking, pregnancy, long periods of bed rest, or standing
- Pulses: strong and symmetrical
- Skin: Mottling with brown pigmentation at ankles, veins may be visibe; legs or feet bluish when dependent, dermatitis, warm at ankle
- Edema: Present
- Ulcers:at bonds of Unlikely
- Pain: aching, cramping, particulary when dependent may have nocturnal creamps
- Skin and Hair Normal.
How do you diagnose Hypertension
- blood pressure equal or greater than 140/90
- BP taken twice on two differnt occasions, two weeks apart and is averaged.
BP drops upon standing
How long before lifestyle change helps
How often do you change Unna boots
weekly, or according to facility policy
5 P's of arterial disease
Angina - chest pain from reduced blood flow narrowing blood vessels
- stable: triggerby by physical activity or stress
- Variant: caused by spasms, not precipitating factors.
- Unstable: medical emergency usually caused by occlucion of coronary arteries.
- Diagnosis - ECG, stress test, cardiac cath, history,
- Nursing Management: drug therapy - Nitro, morphine, oxygen asprin
- Closed vs open
- CABG - coronary artery bypass
- Valve replacement
- heart transplant: non-smoker, non- drinker, must have quit for 6 mo.
- Pre-op: series of diagnostic test, exams teachings: expectations, procedure, what to expect, equipment,
- Post-op: monitor r/r chst tubes, reexpansion of lungs,
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