Care of Patient with Cardiovascular or Peripheral Vascular Disease

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Care of Patient with Cardiovascular or Peripheral Vascular Disease
2013-11-07 13:08:51
Cardiovascular Peripheral Vascular Disease

Mosby's Chapter 48
Show Answers:

  1. Aneurysm
    an enlarged, dilated portion of an artery that is more than one and a half times the artery's circumference.
  2. Angina Pectoris
    paroxysmal thoracic pain and choking feeling caused by decreased oxygen or anoxia of the myocardium
  3. Arteriosclerosis
    a common arterial disorder characterized by thickening, loss of elasticity, and calcification of arterial walls, resulting in a decreased blood supply
  4. Atherosclerosis
    common arterial disorder characterized by yellowish plaques of cholesterol, lipids, and cellular debris in the inner layers of the walls of large and medium-size arteries
  5. Bradycardia
    slow rhythm characterized by a pulse rate of fewer than 60 beats per minute
  6. B-type natriuretic peptide (BNP)
    neurohormone secreted by the heart in response to ventricular expansion
  7. Cardioversion
    the restoration of the heart's normal sinus rhythm by delivery of a synchronized electric shock through two metal paddles placed on the patient's chest
  8. Coronary artery disease (CAD)
    term used to describe a variety of conditions that obstruct blood flow in the coronary arteries
  9. Defibrillation
    the termination of ventricular fibrillation by delivering a direct electrical countershock to the patient's precordium
  10. Dysrhythmia
    any cardiac rhythm that deviates from normal sinus rhythm
  11. Embolus
    a foreign object, a quantity of air or gas, a bit of tissue, or a piece of a thrombus that circulates in the bloodstream until it becomes lodged in a vessel
  12. Endarterectomy
    the surgical removal of the intimal lining of an artery
  13. Heart failure
    a syndrome traditionally defined as circulatory congestion as a result of the heart's inability to act as an effective pump
  14. Hypoxemia
    an abnormal deficiency of oxygen in the arterial blood
  15. Intermittent claudication
    a weakness of the legs accompanied by cramplike pains in the calves caused by poor circulation of the arterial blood to the leg muscles
  16. Ischemia
    decreased blood supply to a body organ or part, often marked by pain and organ dysfunction
  17. Myocardial infarction (MI)
    an occlusion of a major coronary artery or one of its branches with subsequent necrosis of myocardium caused by atherosclerosis or an embolus
  18. Occlusion
    an obstruction or closing off in a canal, vessel, or passage of the body
  19. Orthopnea
    an abnormal condition in which a person must sit or stand to breathe deeply or comfortably
  20. Peripheral
    pertaining to the outside, surface, or surrounding area
  21. Pleural effusion
    an abnormal accumulation of fluid in the thoracic cavity between the visceral and parietal pleurae
  22. Polycythemia
    abnormal increase in the number of red blood cells in the blood
  23. Pulmonary edema
    the accumulation of extravascular fluid in lung tissues and alveoli, most often caused by HF
  24. Tachycardia
    a rapid, regular rhythm origination in the SA node characterized by a HR of 100-150 bpm or more
  25. Layers of heart wall
    • pericardium
    • myocardium
    • endocardium
  26. Heart chambers
    • right atrium
    • right ventricle
    • left atrium
    • left ventricle
  27. Heart valves
    • atrioventricular (AV) valves (2)
    • tricuspid valve
    • mitral valve
    • semilunar valves
    • pulmonary semilunar valves
    • aortic semilunar valve
  28. Impulse pattern
    SA node-AV node-bundle of His-right and left bundle branches of AV bundle-Purkinje fibers
  29. Pericardium
    • two layered, serous membrane that covers the enter heart
    • contains serous fluid that allows friction free movement of the heart as it contracts and relaxes
    • outer most layer of the heart
  30. Myocardium
    • bulk of heart wall
    • thickest and strongest layer of heart
    • composed of cardiac muscle tissue
    • contraction is responsible for pumping blood
  31. Endocardium
    • innermost layer of heart
    • composed of thin layer of connective tissue
    • lines interior of heart, the valves, and the large vessels of heart
  32. Septum
    muscular partition dividing left and right side of heart
  33. Right atrium
    • upper right chamber
    • receives deoxygenated blood from the body
    • superior vena cava returns blood from head, neck arms
    • inferior vena cava returns blood from lower body
    • coronary vein returns blood from the heart muscle to the coronary sinus
  34. Right ventricle
    • lower right chamber
    • receives deoxygenated blood from the right atrium
    • pumps blood to the lungs via the pulmonary artery to release carbon dioxide and receive oxygen
  35. Left atrium
    • upper left chamber
    • receives oxygenated blood from the lungs via the pulmonary veins
  36. Left ventricle
    • lower left chamber
    • receives oxygenated blood from the left atrium
    • pumps oxygenated blood out through the aorta to all parts of the body
  37. Atrioventricula (AV) valves
    • located between the atrium and the ventricles
    • the right AV valve located between the right atrium and the right ventricle called the tricuspid valve
    • the left AV is called the mitral valve located between the left ventricle and left atrium
  38. Tricuspid valve
    • contains 3 flaps
    • located between the right atrium and right ventricle
  39. Mitral valve
    • contains two cusps
    • located between the left atrium and left ventricle
  40. chordae tendineae
    connect the AV valves to the walls of the heart and work with the papillary muscles to make tight seal and prevent backflow
  41. Pulmonary semilunar valve
    • located between the right ventricle and the pulmonary artery
    • blood is pushed out of the right ventricle and travel to the lung via the pulmonary artery
  42. Aortic semilunar valve
    located between the left ventricle and the aorta
  43. Sinoatrial (SA) node
    • initiates heartbeat
    • located in the upper part of the right atrium, just beneath the opening of the superior vena cava
    • known as the pacemaker
  44. AV node
    slows the impulses to allow the atrium to complete contraction and to allow the ventricles to fill
  45. Bundle of His
    • group of conduction fibers
    • divides into right and left branches of AV bundle to travel to smaller branches called Purkinje fibers
  46. Systole
    stage of contraction
  47. Diastole
    • phase of relaxation
    • the period between contraction of the atria or the ventricles during which blood enters the relaxed chambers from the systemic circulation and the lungs
  48. Lubb
    heard when the AV valves close
  49. Dubb
    heard when the semilunar valves close
  50. Capillaries
    • tiny blood vessels joining arterioles and venules
    • allows exchange of products and byproducts between the tissues and blood
  51. Arteries
    • large vessels carrying blood away from the heart
    • branch into tiny vessels called arterioles
  52. Veins
    vessels that convey blood from the capillaries and return it to the heart
  53. Arterioles
    • branches of arteries
    • blood vessels of the smallest branch of the arterial circulation
    • delivers blood to the tissues
  54. Venules
    tiny veins that link with the larger veins and return to the heart
  55. Blood vessel pattern
  56. Coronary circulation
    the delivery of oxygen and nutrient rich arterial blood to cardiac muscle tissue and the return of oxygen poor blood from this active tissue to the venous system
  57. Aorta
    • largest artery of the body
    • composed of four parts: ascending aorta, the arch, the thoracic portion of the descending aorta, the abdominal portion of the descending aorta
  58. Vena cava
    one of the two large veins returning blood from the peripheral circulation to the right atrium of the heart
  59. Alveoli
    air sacks
  60. Pulmonary circulation
    superior or inferior vena cava-right atrium-tricuspid valve-right ventricle-pulmonary semilunar valve-pulmonary artery-capillaries in the lungs-pulmonary veins-left atrium-bicuspid valve-left ventricle-aortic semilunar valve-aorta
  61. Hyperlipidema
    • Cholesterol <200
    • HDL >40
    • LDL<100
  62. Cardiovascular risk factors
    • family history
    • age
    • gender
    • cultural/ethnic considerations
  63. Modifiable factors
    • smoking
    • hyperlipidemia
    • hypertension
    • diabetes
    • obesity
    • sedentary lifestyle
    • stress
    • psychosocial factors
  64. Causes of sinus tachycardia
    • exercise
    • anxiety
    • fever
    • shock
    • medications
    • HF
    • excessive caffeine
    • recreational drugs
    • tobacco use
  65. Sinus tachycardia s/s
    • occasional palpitations
    • hypotension
    • angina
  66. Causes of sinus bradycardia
    • sleep
    • vomitting
    • intracranial tumors
    • MI
    • drugs
    • carotid sinus massage
    • vagal stimulation
    • endocrine disturbances
    • increased intracranial pressure
    • hypothermia
  67. Sinus bradycardia s/s
    • fatigue
    • lightheadedness
    • syncope
  68. Supraventricular tachycardia
    • sudden onset of a rapid heartbeat
    • originates in atria
    • pulse rate of 150-250
  69. Supraventricular tachycardia causes
    • drugs
    • alcohol
    • mitral valve prolapse
    • emotional stress
    • smoking
    • hormone imbalance
    • usually not associated with heart disease
  70. Supraventricular tachycardia s/s
    • palpitations
    • lightheadedness
    • dyspnea
    • angina pain
  71. Atrial fibrillation
    • electrical activity in the atria is disorganized causing the atria to fibrillate or quiver
    • very rapid production of atrial impulses
  72. Atrial fibrillation causes
    • cardiac surgery
    • longstanding hypertension
    • pulmonary embolism
    • atherosclerosis
    • mitral valve disease
    • HF
    • cardiomyopathy
    • congenital abnormalities
    • chronic obstructive pulmonary disease
    • thyrotoxicosis
  73. Atrial fibrillation s/s
    • atrial rate of 350-600
    • pulse deficit
    • palpitations
    • dyspnea
    • angina
    • lightheadedness
    • syncope
    • fatigue
    • change in LOC
    • pulmonary edema
  74. Atrioventricular block
    • occurs when a defect in the AV junction slows or impairs conduction of impulses from the SA node to the ventricles
    • 3 types-first, second, third
  75. Atrioventricular block causes
    • atherosclerotic heart disease (ASHD)
    • MI
    • heart failure (HF)
    • digitalis toxicity
    • congenital abnormality
    • drugs
    • hypokalemia
  76. Atrioventricular block s/s
    • no symptoms for 1st degree
    • vertigo, weakness and irregular pulse for 2nd degree
    • hypotension, angina, bradycardia and HF for 3rd degree
  77. Premature ventricular contractions
    • PVC's
    • abnormal heartbeats that arise from the right or left ventricle
    • early ventricular beats that occur in conjunction with the underlying rhythm
  78. PVC causes
    • irritability of the ventricular musculature
    • exercise
    • stress
    • electrolyte imbalance
    • digitalis toxicity
    • hypoxia
    • MI
  79. PVC s/s
    • depends on frequency and effect on hearts ability to pump blood effectively
    • some pts may experience:
    • palpitations
    • weakness
    • lightheadedness
  80. Ventricular tachycardia
    • occurs when three or more successive PVC's occur
    • ventricular rate is >100bpm
  81. Ventricular fibrillation
    • ventricular musculature of the heart is quivering
    • rapid and disorganized ventricle pulsation
  82. Ventricular fibrillation causes
    • myocardial ischemia
    • infarction
    • untreated VT
    • electrolyte imbalances
    • digitalis or quinidine toxicity
    • hypothermia
  83. Ventricular fibrillation s/s
    • no cardiac output
    • loss of LOC
    • lack of pulse
    • decrease in blood pressure
    • decrease in respirations
    • seizures
    • sudden death
    • defibrillation required within 15-20 seconds
  84. Assessment of patient with cardiac dysrhythmia
    • Subjective: symptoms associated with particular dysrhythmia may include palpitations, skipped beats, nausea, lightheadedness, vertigo, anxiety, dyspnea, fatigue and chest discomfort
    • Objective: visual observation, syncope, irregular pulse, tachycardia, tachypnea
  85. Diagnostic tests for pt with dysrhythmia
    • ECG
    • Telemetry
    • Holter
  86. Medications for cardiac dysrhythmias
    • Cardioglycoside-Digoxin
    • Antidysrhythmic
    • Beta adrenergic blockers
    • Calcium channel blockers
    • inotropic agent
    • anticoagulant
  87. Nursing interventions for pt with cardiac dysrhythmias
    • symptomatic relief
    • promotion of comfort
    • relief of anxiety
    • emergency action
    • patient teaching
    • assess apical pulse
    • explain diagnostic and monitoring devices
    • teach importance to stop smoking
    • teach about medication therapy
    • teach how to take pulse
    • teach to avoid exercising beyond the tolerance level
    • avoid strenuous or isometric activity
    • teach reserving energy
    • stress management
  88. Cardiac arrest
    sudden cessation of cardiac output and circulatory process
  89. Cardiac arrest causes
    • severe VT
    • ventricular fibrillation
    • ventricular asystole
  90. Cardiac arrest s/s
    • abrupt LOC with no response to stimuli
    • gasping respirations followed by apnea
    • absence of pulse
    • absence of blood pressure
    • pupil dilation
    • cyanosis
  91. Cardiac arrest treatment
    • CPR
    • A-airway B- breathing C- circulation
  92. Artificial cardiac pacemaker
    • made of titanium
    • controls pacing system
    • one or more leads placed into the heart
    • initiates or controls HR by delivering electrical impulse via electrode to the myocardium
    • electrodes placed in right atrium and/or right ventricle
    • used when medications don't work for dysrhythmias such as 2nd and 3rd degree AV block
  93. Pacemaker nursing interventions
    • monitor HR and rhythm by apical pulse
    • VS
    • LOC checks
    • observe insertion site for erythema, edema, and tenderness
    • teach medical alert bracelet
    • report s/s of failure: weakness, vertigo, chest pain, pulse changes
  94. Lumen
    a cavity or channel within any organ of the body
  95. Angina pectoris patho
    • occurs when the cardiac muscle is deprived of oxygen
    • atherosclerosis of the coronary arteries creates narrowed lumina of arteries which prevents delivery of oxygen rich blood to the myocardiam causing ischemia of the heart muscle
  96. Angina s/s
    • Pain-described as heaviness or tightness in chest
    • Pain is substernal or retrosternal
    • pain radiates to: down thelft inner arm to the little finger, upward to jaw and shoulder
    • pain described as pressure or squeezing
    • may exhibit dyspnea, anxiety, apprehension, diaphoresis, nausea
    • symptoms in woman differ. report heaviness, squeezing or pain in the left side of the chest, or pain in the abdomen, arm, mid-back, or scapular pain.
    • woman may also c/o palpitations, chest discomfort
  97. Angina assessment
    • Subjective: pts statement regarding location, intensity, radiation and duration of pain. Sense of impending death. Assess precipitating factors, relief measures.
    • Objective: pts behavior, rubbing the left arm or pressing a fist against the sternum. Monitor V/S
  98. Angina tests
    • Patient hx
    • ECG
    • Holter monitoring
    • exercise stress test
    • Thallium 201 scanning
    • PET
    • coronary angiography
  99. Angina treatment
    • control symptoms by reducing cardiac ischemia
    • risk factors are identified and corrected if possible
    • precipitating factors are identified and avoided
    • Antiplatelet aggregation therapy-aspirin
    • vasodilators
    • beta adrenergic blocking agents
    • calcium channel blockers
    • nitroglycerin sublingual- up to 3 times
  100. Angina surgical interventions
    • Coronary artery bypass graft
    • percutaneous transluminal coronary angioplasty
    • stent placement
  101. Coronary artery bypass graft
    • surgical management of pt with ASHD and CAD
    • blood flow to the myocardium is through grafts bypassing occluded coronary arteries
  102. Percutaneous transluminal coronary angioplasty
    • PTCA
    • invasive procedure used to widen the narrowing in a coronary artery without open heart surgery
    • need to sign consent for CABG when done
    • catheter guided by fluoroscopy through the femoral or brachial artery to the coronary arteries where a balloon is inflated against the narrowing wall
  103. Stent placement
    • used to treat abrupt or threatened vessel closure after PTCA
    • expandable meshlike structures designed to maintain vessel patency by compressing the arterial walls and resisting vasoconstriction
    • placed over the angioplasty site to hold vessel open
  104. Angina nursing interventions
    • promote comfort
    • promote tissue perfusion
    • promote activity and rest
    • promote relief of anxiety and a feeling of well being
    • teach the patient and family
  105. Myocardial infarction patho
    • occlusion of a major coronary artery or one of its branches with subsequent necrosis of myocardium caused by atherosclerosis or an embolus.
    • interrupted blood supply leads to ischemia
    • ischemia lasting 35-45 minutes causes necrosis causing impairment of the ability of the cardiac muscle to contract and pump blood.
    • Collateral circulation allows for circulation of blood through new vessels that develop to compensate for the loss of circulation from the occluded artery
  106. Myocardial Infarction (MI) s/s
    • Subjective:
    • heavy pressure or squeezing in center of chest behind sternum
    • Pain, retrosternal and in heart region, often radiating down the left arm and to the neck, jaw, and teeth
    • anxiety
    • dyspnea
    • weakness, faintness
    • nausea
    • Objective:
    • Pallor
    • erratic behavior
    • hypotension, shock
    • cardiac rhythm changes
    • vomiting
    • fever diaphoresis
  107. Myocardial infarction tests
    • Serum tests: CK-MB, myoglobin, troponin I, WBC elevated of 12000-15000/mm
    • 12 lead ECG-ST segment elevation and development of Q waves. In time the ST segment returns and the T wave inverts
    • chest x-ray
  108. Myocardial infarction medical management
    • prevention of further tissue injury and limiting the size of the infarction
    • rapid diagnosis needed
    • medications such as morphine and diazepam use to alleviate pain and anxiety
    • continuous IV of amiodarone for PVCs
    • Beta adrenergic blockersĀ  early in MI
    • Angiotensin converting enzyme (ACE) used after MI to prevent or slow progression of HF
    • Calcium channel blockers
    • Oxygen
    • Fibrinolytic agents used to attempt reprefusion
    • Reprefusion needs to happen 3-5 hours after onset of MI
    • mortality and infarction size can be significantly reduced if thrombolytic therapy starts within 30-60 minutes of symptom onset
  109. Myocardial infarction nursing interventions
    • administer O2
    • IV morphine sulfate for relief of pain and anxiety and to reproduce vasodilation
    • heparin therapy or unfractionated or low molecular weight heparin to inhibit further clotting and prevent re-occlusion of the coronary artery after the thrombolytic therapy opens the vessel
    • antiplatelet agents such as aspirin and ticlopidine to decrease platelet release of tromboxane
    • IV nitroglycerin may help patients with left ventricular infarctions
    • administer lipid lowering agents
    • stool softener to reduce valsalva maneuver
  110. Heart failure patho
    • when heart is no longer able to pump enough blood to sustain the body's metabolic needs
    • once called congestive heart failure
    • neurohormonal problem as a result of chronic release in the body of substances such as catecholamines (epinephrine and norepinephrine).
    • circulatory congestion and compensatory mechanisms may occur
    • may develop after an MI, in response to prolonged hypertension or diabetes, or in relation to valvular or inflammatory HD
    • Left ventricle is most often affected by coronary atherosclerosis and hypertension, HF usually begins there.
    • untreated left sided HF leads to right sided HF
  111. Left ventricular failure
    • left ventricle is unable to pump enough blood to meet the body's demands
    • decreased cardiac output
    • pulmonary congestion-increased pressre in the left side of the heart backs up into the pulmonary system and the lungs become congested with fluid and fluid leaks through the engorged capillaries and permeates air spaces in the lungs
  112. Left ventricular failure s/s
    • dyspnea
    • paroxysmal nocturnal dyspnea
    • orthopnea
    • pulmonary crackles
    • wheezing
    • pink frothy sputum
    • cough
  113. Right ventricular failure
    • right ventricle is unable to pump effectively against increased pressure in the pulmonary circulation
    • most often a result of blood backing up fromĀ a failing left ventricle or chronic pulmonary disease (cor pulmonale) and pulmonary hypertension
    • results in peripheral congestion and inability to accommodate all the venous blood that is normally returned to the right side of the heart causing it to be reflected backward into the systemic circulation forcing fluid out of the vasculature into interstitial tissue (peripheral edema)
  114. Right ventricular failure s/s
    • distended jugular veins
    • anorexia, nausea, and abdominal distention
    • liver enlargement with right upper quadrant pain
    • ascites
    • edema in feet, ankles, sacrum, may progress up the legs into thighs, external genitalia, and lower trunk
  115. What does a weight gain of 2.2lbs signify?
    a gain of 1L of fluid
  116. Heart failure assessment
    • Subjective:
    • c/o dyspnea, orthopnea, paroxysmal nocturnal dyspnea and cough.
    • fatigue
    • anxiety
    • weight gain
    • edema
    • psychosocial stress
    • major depression
    • Objective:
    • respiratory distress
    • edema
    • abdominal distention secondary to ascites
    • weight gain
    • adventitious breath sounds
    • abnormal heart sounds (gallops and murmurs)
    • activity intolerance
    • jugular vein distention
    • oliguria
    • cyanosis
  117. Heart failure tests
    • dependent on s/s
    • chest xray reveals pulmonary vascular congestion, pleural effusion, cardiomegaly (cardiac enlargement)
    • ECG reveals dysrhythmias
    • echocardiogram to determine valvular heart diseas, presence of pericardial fluid, HF, and ejection fraction
    • pulmonary artery catherization to assess right and left ventricular function
    • stress test
    • cardiac catherization
    • MUGA scanning
    • electrolytes, sodium, calcium, magnesium and potassium
    • blood chemistry
    • LFT
    • BNP
    • arterial blood gas
  118. Heart failure medical management
    • increase cardiac efficiency with digoxin and vasodilators
    • ACE inhibitors decrease peripheral vascular resistance, improve cardiac output and have proven to extend lives
    • beta blockers to prevent cardiac remodeling (occurs when the left ventricle dilates, hypertrophies and develops a more spherical shape causing stress on the ventricle walls, increasing the magnitude of regurgitation through the mitral valve, and depresses mechanical performance.
    • angiotensin II receptor blockers selectively and competitively block the vasoconstrictive and aldosterone secreting effects of angiotensin leading to vasodilation
    • lower oxygen requirements of the body systems
    • treat edema and pulmonary congestion with diuretics, sodium restricted diet and restricted fluid intake with daily weight
  119. Heart failure nursing interventions
    • prevent disease progression and complications
    • V/S
    • respiratory distress
    • pulmonary edema
    • monitor s/s of left sided vs right sided HF
    • elevate legs to decrease edema
    • watch abdominal girth
    • monitor body weight
    • assess lungs for crackles or wheezes
    • note coughing
    • note dyspnea
    • assess for depression
  120. Heart failure key components of care
    • assess left ventricular systolic function
    • upon discharge and left ventricular ejection fraction is <40% administer ACE inhibitor or angiotensin
    • at discharge administer anticoagulant if chronic or recurrent atrial fibrillation
    • encourage smoking cessation
    • instruct patient on activity, diet medication, f/u appointment, weight monitoring and what to do if symptoms worsen
    • provide flu and pneumonia shot
    • at discharge institute optional beta blocker therapy for stabilized patients with left ventricular systolic dysfunction who have no contraindications
  121. Guidelines for nursing interventions for the patient with heart failure
    • provide O2
    • administer oxygen by nasal cannula for dyspnea
    • semi fowlers or high fowlers position
    • energy conservation
    • encourage activity within prescribed restrictions
    • assist with ADL's
    • provide diversionary activities
    • monitor for signs of fluid and potassium imbalance
    • skin care
    • adequate nutritional intake
    • monitor constipation
    • give prescribed medications
    • give pt and family opportunities to discuss concerns
    • teach about disorder and self care
  122. Pulmonary edema patho
    • accumulation of extravascular fluid in lung tissues and alveoli, most often caused by HF
    • is an acute and extensive, life threatening complication of HF caused by severe left ventricular dysfunction
    • fluid from the left side of the heart backs up into the pulmonary vasculature and results in extravascular fluid accumulation in the interstitial space and alveoli
  123. Pulmonary edema s/s
    • severe respiratory distress
    • frothy sputum
    • restlessness
    • vague uneasiness
    • agitation
    • disorientation
    • diaphoresis
    • severe dyspnea
    • tachypnea
    • tachycardia
    • pallor or cyanosis
    • cough
    • audible wheezing, crackles
    • cold extremities
  124. Pulmonary edema tests
    • chest xray
    • arterial blood gas
    • Pao2 and Paco2
  125. Pulmonary edema medical management
    • simultaneous intervention to promote oxygenation, improve cardiac output and reduce pulmonary congestion
    • high fowlers or arms over side of bed with arms supported on bedside table
    • morphine sulfate
    • oxygen at 40-100%, nonrebreather face mask
    • administer sublingual nitroglycerin
    • diuretics
    • foley
    • inotropic agents
    • nitroprusside
  126. Pulmonary edema nursing interventions
    • O2
    • place patient upright with legs in a dependent position to decrease venous return to the heart, relieving pulmonary congestion and dyspnea
    • monitor arterial blood gas
    • administer drugs
    • lung sounds
    • emotional support
    • V/S
    • I&O
    • serum electrolytes
  127. Valvular heart disease
    • stenosis: thickening of the valve tissue, causing the valve to narrow
    • insufficiency: occurs when the valve is unable to close completely
    • include mitral stenosis, mitral insufficiency, aortic insufficiency, aortic stenosis, tricuspid insufficiency, tricuspid stenosis, pulmonary insufficiency and pulmonary stenosis
    • occur primarily from congenital conditions or hx of rheumatic fever (showing 10-40 post fever)
  128. Valvular heart disease s/s
    • mitral valve stenosis-dyspnea on exertion, hemoptysis, fatigue, palpitations, loud accentuated s1, low pitched, rumbling diastolic murmur, atrial fibrillation on ECG
    • mitral valve regurgitation-Acute: generally poorly tolerated with fulminating pulmonary edema and shock developing rapidly, new systolic murmur. Chronic: weakness, fatigue, exertional dyspnea, palpitations, and s3 gallop
    • aortic valve stenosis-angina, syncope, dyspnea on exertion, heart failure, normal or soft S1, diminished or absent S2
    • Aortic valve regurgitation-Acute: abrupt onset of profound dyspnea, chest pain, left ventricular failure and shock. Chronic: fatigue, exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, waterhammer pulse, heaving precordial impulses, diminished or absent S1, S3 or S4
    • Tricuspid and pulmonic stenosis-Tricuspid: peripheral edema, ascites, hepatomegaly, diastolic low pitched murmur. Pulmonic: fatigue, loud mid systolic murmur
  129. Valvular heart disease tests
    • chest xray
    • ECG
    • echocardiogram
    • cardiac catherization
  130. Valvular heart disease medical management
    • activity limitations
    • sodium restricted diets
    • diuretics
    • digoxin
    • anti-dysrhythmics
    • surgical procedures: open mitral commissurotomy, valve replacement (
  131. Rheumatic heart disease patho
    rhumatetic fever