RN41-EX4-Cardiovascular.txt

Often starts in the sinus node a slow heart rate may occur because the sinus node. We have discharges electrical impulses at a slower than normal rate. It pauses or fails to discharge at a regular rate and discharges an electrical impulse thats blocked before causing the atria to contract

Is caused by the destruction of the normal electrical impulses that control the rhythm of the heart's pumping action. Abnormal circuitry causes an overlap

Is a heart rhythm problem when the heart beats with rapid erratic electrical impulses. This causes pumping chambers in your heart, the ventricles in the heart to quiver uselessly instead of pumping blood. During ventricular fibrillation the BP just drops cutting of blood supply to the vital organs. Ventricular fibrillation is frequently triggered by a heart attack.

Can have normal electrical impulses and the ventricles may occur as isolated extra beats brief runs of extra beats or long runs of rapid and often dangerous arrhythmias. Ventricular arrhythmias may occur because the tissue is damaged, scarred and often inflamed

Aortic, pulmonic, erbs, tricuspid, and mitral. Now remember the aortic pulmonic are the second intercostal space midclavicular line. Erbs is the third intercostal mid-clavicular line and the tricuspid is close to the sternum at the fifth intercostal space in the mitral is fifth intercostal space near the Mid-clavicular line. The sounds associated with the mitral valve are accentuated by turning the patient to the left side which brings the heart closer to the chest wall

You hear Gallup rhythms generate a more low pitched sound and are more easily heard with the bell

Should never be palpated at the same time to avoid vagal stimulation, dysrhythmias and decreased cerebral blood flow

Is best used for higher pitched sounds such as s1 and s2

Is a sound caused by turbulent blood flow in an artery

Are sustained lifts over the pericardium that can be observed or palpated

Patient is instructed to keep a daily diary describing the daily activities while Holter monitoring is being accomplished to help correlate any rhythm disturbances with patient activities. Patient should not take a shower or bath while they have a holter monitor but should continue their usual daily activities. The recorder stores the information about the patients with them until the end of the testing when it is removed and the data is analyzed

When the patient is lying flat the jugular veins are at the level of the right atrium so what JVD is common but doesn't always mean it is clinically significant, it is when it persists when a patient is sitting at a 35 to 45 degree angle or greater is when is significant. The nurse can use a ruler to determine the level of the JB da above the heart.

Sound caused by turbulent flow through the heart

The point of maximal impulse should be left at the fifth intercostal space left mid clavicular line anytime the PMI is outside of this landmark could mean the heart is enlarged and it could mean ventricular hypertrophy

The difference between simultaneously obtained apical and radial pulses and indicates that there may be a cardiac dysrhythmias that would be detected with ECG monitoring.

Palpable vibrations felt when there is a turbulent blood flow through the heart or in a blood vessel. Visible pulsation of the abdominal aorta is commonly observed in at the epigastric area for thin individuals

You might hear a bundle branch block or slight increases in PR interval or QRS duration. Resting HR does not normally change with ageing

Onset of ventricular systole. Closing of tricuspid and mitral valve. Soft lub sound

Onset of diastole. Closing of aortic and pulmonic valves. Sharp dub sound

Reflect the amount of time it takes for the impulse to spread through the atria

Time taken for depolarization of both ventricles. This is ventricular contraction

Interval measurement made from the ECG of the time from the onset of the electrical waves in the heart to when the entire heart has reset and is ready for the next beat. Shorter at faster rates and lengthens at slower rates

Feature of myocardial infarction and angina

Segment depression could mean myocardial infarction

Premature atrial contraction. Irregular rhythm abnormal shape of P wave and normal QRS. Occurs with a premature atrial complex

Premature ventricular contraction. Contraction originating in the ectopic focus in the ventricles and is characterized by a premature a wide distorted QRS complex with the P wave and the PR interval buried in the distorted QRS complex resulting in an irregular rhythm.

Ventricular tachycardia. 100 to 250 bpm. An absent P wave, wide distorted QRS occurs with ventricular tachycardia

Patient sitting with both feet flat on the floor and BP taken on both arms

Brain natriuretic peptide. An increased level could be a marker for heart failure

Nurses will probably need to teach the patient that the procedure is quick and the involves very little risk

Starts to elevate on average after 4 to 6 hours after an MI

Useful in assessing cardiovascular risk

Is a contrast dye used for a procedure. Check for iodine base, it can cause a warm flushing when the dye is injected so it is important to let the patient know this can happen

Is useful in assessing cardiovascular risk

Specific to MI and infarction but it doesn't usually increase until 4 to 6 hours after in MI has occurred

Good cholesterol. The higher the number the lower the risk. This is because the HDL cholesterol protects against heart disease by taking the bad cholesterol out of the blood and keeping it from building up in the arteries

The lab result to assess for an MI, myoglobin, or risk for coronary artery disease

Can build up in the walls of the arteries and increase chances of getting a heart attack lab results

Mean arterial pressure is calculated using the formula . The systolic pressure plus two times the diastolic pressure divided by 3

Is contraindicated for patients with anything metallic

ECG changes associated with coronary ischemia: such as T wave inversion or an ST segment depression could mean that the myocardium is not getting enough oxygen

Need to be NPO for at least 6 hours preceding this test and after procedure monitoring for return of gag reflex

Mild, no limitation of physical activity. Ordinary physical activity does not cause undo fatigue or palpitation

Mild, slight limitation of physical activity. Comfortable at rest but ordinary physical activity result in fatigue, palpitations or dyspnea

Moderate. Marked limitations of physical activity. Comfortable at rest but less than ordinary activity causes fatigue, palpitations, or dyspnea

Severe. Unable to carry out any physical activities without discomfort. Symptoms of cardiac insufficiency at rest if any physical activity is undertaken, discomfort is increased

Exercising aerobicly for 30 minutes most days of the week. The goal for anti-hypertensive therapy for a patient with hypertension and heart failure is to have a blood pressure of less than 130/80

Usually asymptomatic until target organ damage has happened. Think about the organs that are affected. Hypertension: heart, brain-stroke, in particularly look at kidneys, their kidneys could fail

BP should be checked by provider every 3 to 6 months

DASH: the dietary approach to stop hypertension is the DASH diet, high in fiber but increasing fiber alone will not prevent HTN from developing. They're going to have to increase the intake of calcium rich food, caffeine restriction, decrease protein. Usually nuts are recommended they are high in beneficial nutrients and 4 to 5 servings weekly in a DASH diet.

Especially if someone has a7 increase over age 50, it could be secondary to some other problems. So it would be important for them to look at what are some other issues. Looking at reviewing their dietary salt or fat intake. Since non compliance with anti hypertensive therapy is common a nurses initial action should be to determine whether or not the patient is taking the medication as prescribed or can they afford the medication

Having a patient to self-monitor at home will give reliable indication of whether the patient has hypertension as well. Sometimes it could be high due to the white coat hypertension

Frequently cause orthostatic hypotension. Patients should be taught to change positions slowly to allow the vascular system time to compensate for position changes

Make sure you are looking out for the side effects like bradycardia or bronchospasms

Like verapimil, nifedioine, diltiazam: they relax blood vessels and increase blood supply and oxygen to the heart while decreasing the hearts workload. CCBs can be taken with food or milk, just have to watch out for constipation and probably should not drink alcohol, grapefruit or drink fruit juice

Comes from the leaves of the digitalis plant and it makes the heart beat stronger with a more regular rhythm. You'll see it used also to treat heart failure and atrial fibrillation and should be taken at the same time everyday with a full glass of water. It should be stored at room temperature away from moisture and heat

Hypokalemia is a frequent adverse effect of a loop diuretic and can cause life-threatening dysrhythmias health care providers should be notified of a potassium level immediately and administration if they need potassium supplements. Spironolactone, you would have to watch for potassium being too high

Look up on the Internet

They would need frequent monitoring of BP when patient is receiving a rapid acting IV antibiotics if medications. This can be easily accomplished with automated blood pressure machine or an arterial line