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The amount of resistance to the ejection of blood from the ventricle.
The amount of blood ejected per heart beat, AVG. 70 ml.
Increased after load= Decreased stroke volume.
Myocardial Infarction (MI)
What happens to the myocardium during infarction?
Patient is asked to take stool softners, so they dont strain when taking a crap.
The myocardium is starved for O2 and the tissues dies and damage results.
When do Levels rise?
- Troponin 1 indicates some amount of cardiac muscle damage with levels above .4 ng/ml.
- This is an accurate and reliable indicator of an myocardial infarction.
- Levels increase within hours and can stay elevated for 3 weeks.
ACS (Acute Coronary Syndrome)= Acute Myocardial Infarction
- Not normal symptoms, can be shown as secondary symptoms.
- SOB, indigestion, nausea, anxiety, cool/clamy skin, tachycardia, tachypnea, or feeling of doom.
- Women are not usually diagnosed right off becaue they show these secondary s/s.
Angina Pectoris= Chest Pain=Symptom
Atherosclerosis and increased O2 demand: from exercise stress, cold/vasoconstriction, and heavy meal causing blood to go to guts.
Decreases Myocardial oxygen consumption and are a vasodilator.
Why is walking part of plan of care?
- I-Diagnosis of Atherosclerosis
- II-After discharge, exercise, diet, and eduction. 1-6 months
- III- Long-term outpatient program.
Because walking is good for heart health.
Interventions for reducing myocardial oxygen consumption-
Rest, nitrates, oxygen, beta-blockers, calcium channel blockers, aspirin, and reduce risk factors like; stop smoking, HTN, and etc.
Cardiomyopathy= Heart Disease
Distingushing Characteristics of Dilated-
Dilated Most common, significant dilation of ventricles without hypertrophy (increased muscle wall thickness).
Manifestations- Arrythmogenic right ventricle, hypotension, fatigue, cough, orthopnea, edema, nausea, chest pain, palpitations, dizziness, and syncopy.
How is fluid balance assessed?
How to reduce fluid volume?
Labs that can diagose HF?
- Heart Failure=Inability of heart to pump sufficient blood to meed the needs of the tissues. Characterized by fluid overload or inadequate tissue perfusion.
- Edema, and daily weight.
- Dyspnea, SOB, arthopnea, cough, pulmonary crackles, low 02 stats.
- Ace inhibitiors and diuretics.
- Symptoms, echocardiogram, cardiac catheterization, chest x-ray, EKG, and stress test.
Furosemide (Lasix)= Loop Diuretic
- Decrease water levels fast.
- Decrease Potassium Levels.
Warfarin (Coumadin)=Anticoagulant Drug.
Patient are more prone to bleeding.
How to prevent complication-
Venous Insufficiency= Obstruction of the venous valves in the legs or a reflux of blood through the valves.
Elevate legs, compression stocking, avoid crossing legs, keep skin clean, dry, soft, and avoid prolonged sitting and standing.
Peripheral Arterial insufficency= Insufficient arterial blood supply.
Interventions to Promote Circulation-
Exercise program, quit smoking, loose weight, medication, and surgery.
Walking/Exercise, protect from trauma, well fitting shoes, and avoid tight fitting clothes.
5 P's of Circulatory Checks
Varicose Veins= Abnormally dilated, tortuous, superficial veins caused by incompetent venous valves.
Avoid prolonged sitting/standing, compression stocking, elevate legs, frequent walking every hr., etc.
Beta-Adrenergic blocker/Cardiovascular agent working as a drug to control HTN, migranes, and antiarrhythmic effects.
Common side effects-
Reduce myocardial oxygen consumption/reduces workload of heart.
- Bradycardia, lethargy, GI disturbance, CHP, decreased Blood Pressure, and depression.
- Orthostatic hypotension so caution on standing or moving to fast, so you do not pass out and fall.
Primary HTN= High blood pressure where the cause is unknown.
- Overweight, smoking, and drinking too much alcohol.
- The Diagnosis of HTN have elevated reading 3x in several weeks.
- The Silent Killer!
Antihypertensive Drug= Decrease Blood Pressure
Goals of Treatment-
Lower high blood pressure and prevention of CVA or stroke.
Intermittent Claudication= Is defined as resproducible ischemic muscle pain, in one of the most common manifestations of PAD caused by atherosclerosis.
- Ischemic muscle ache or pain.
- Shootng or burning pain in extremity.
- Produces loss of pressure and deep pain sensations.
- Treatment: Walking exercise program.
Peripheral Arterial Occlusive Disease=
Treatment: Protect from trauma, ware well fitting clothes, and avoid tight fitting socks.
- Peripheral Arterial Occlusive Disease= When artery stenosis occurs an ther is insufficient blood flow to the tissue.
- Occurs at neck, abdomen, and extremities.
- Thin, shinny, and taught skin.
- Loss of hain on lower legs.
- Diminished pulses in legs.
- Pallor and unequal pulses.
Calcium channel blockers=
Therpeutic effects for CAD-
Ca2+ channel blockers= Prevents calcium from entering muscle cells, which prevents muscle contractions, it promotes muscle relaxation.
Relaxation of smoothe muscle that surrounds the coronary arteries causing them to relax and dilate, which increases blood flow to the heart.
- Total= Below 200
- LDL= Below 100
- HDL= Above 60
- Triglycerides= Below 150
Loop Diuretics (Lasix)=
Common side effects
- Loop Diuretics= Reduce the vascular responce to Hypotension.
- Drop water levels fast, dehydration, hypotension, and decrease potassium levels.
Buerger's Desease= Inflammation of the small arteries and veins, linked to smoking.
- Encourage cardiovascular exercise.
Well fitting clothes.
- Stop Smoking (Cessation)Avoid cold environments.
- Avoid constriction drugs.
DVT= Deep Vein Thrombosis
DVT= Formation of Thrombus/ Prolonged immobility.
- Pulmonary Embolism
- CVA or Stroke.
- A cardiovascular blockage.
- Monitor: INR
- Antidote: Vitamin K
Color of urine-
- Glomerulonephritis= A bacterial or Viral infection of the Kidneys.
- Proteinuria, edema, irritability, Head ache, malaise, hematuria, azotemia (Increases Nitrigen levels), HTN, dizziness, digestive problems, and Increased BUN/Creatinine levels.
Pink to dark brown cola look.
Urinary Incontinence= Involuntary loss of urine from the bladder.
- Types: Stress (cough or sneeze)
- Reflex (Without control)
- Over flow (weak muscle)
- Functional (nothing wrong)
- Iatrogenic (caused by medicatons)
UTI= An infection of the urinary tract.
Prevention= Drink lots of fluids, pee after sex, hygine, and wear loose clothing.
Clinical manifestation in the ELDERLY: Altered mental status and incontinence.
Bladder Infection = Cystitis
Things contained in it-
Things not supposed to be in it-
Found- Water, sodium, chloride, bicarbonate, potassium, urea, creatinine, and uric acid.
Should not be found- Glucose, protein, or blood.
R/T Hypovolemia and Hypotension
Renin-Angiotensin system= Vasarecta cells monitor BP for: low blood pressure and low blood volume, which causes the release of renic due to low BP.
- Renin changes to Angiotensin.
- Angiotension I converst to Angiotension II, by ace enzyme in the lungs.
- Angiotension II causes vasoconstriction and alderstrone production with ADH to retain sodium and water to raise fluid levels in the cardio vascular system. Which raises BP.
Acute Renal Failure=
ARF= Kidneys can't remove body's metabolic wastes or perform regulatory functions.
Manifestations- Ill apperaence, lethargy, dry skin and mucus membranes, HA, increases BUN/Creatinine, hyperkalema, muscle twitching, and anemia.
Nephrotic Syndrome= Is glomerular premeability, where things are filterd through where they should not be.
Manifestaitons- Proteinuria, Hyperlipidemia, Hypoalbuminemia, edema, HA, Irritability, and malaise.
Difficulty urinating = Dysuria
Interventions- Straight catheter as needed, administer medications as directed, privacy, warm bath, analgesics, and treat infection/ obstruction.
Kidney stones= Nephrolithiasis= Stones in the Kidney.
ESWL ( Extracorporeal shock wave lithotripsy) Most common treatment for stones.
Calcium stones are most common stone.
ESRD (End Stage Renal Disease)= Renal Failure
Disease that increase risk of developing-
Risks- Diabetes, HTN, Chronic Glomerulonephritis, obstruction of urinary tract, medications, or toxic agents.
- Teaching- This drug may cause hypotension, dyspepsia, & N/V.
- Patient should take drug with meals and adhere to perscribed diet.