NCM 118
NCM 118
NCM 118
QRS complex
Cardiovascular Disorders
- Not prolonged; .12-20 secs= 3-5 small boxes
Functions: - Abnormal patterns: Heart block
Limit activity until symptoms resolve MITRAL STENOSIS- obstruction of blood flowing
Hospitalize for close observation from the left atrium into the left ventricle
Avoid Anticoagulants (increased risk of
- Can lead to right-sided heart failure
hemopericardium)
S/Sx:
Pharmacologic:
Dyspnea
NSAID therapy; aspirin preferred in pt. with recent MI
Fatigue
Colchicine 0.6 mg bid- recurrent pericarditis Dry cough
Wheeze
Corticosteroids- refractory or recurrent cases
Atrial Fibrillation
- Prednisone up to 1.5 mg/kg/day x 3-4 wk Heart murmur
may be added in pt. with severe symptoms of
acute pericarditis and suspected connective- Treatment:
tissue disease Anticoagulant
Heart wall: Antianemic
Valvuloplasty
Endocardium- inner layer
Myocardium- muscular middle layer Nx Care:
Epicardium- protective outer layer Advise to avoid strenuous activities and
competitive sports
Chambers:
Right Atrium- receives blood from the vena cava Blood supply:
and coronary sinus Left coronary artery- supply much of the anterior
Left Atrium- Receives blood from the pulmonary wall and most of the left ventricle
veins from the lungs Right coronary artery- supply most of the wall of
Right Ventricle- pumps blood to the pulmonary the right ventricle
trunk to the lings
Left Ventricle- pumps blood to the aorta to the Heart rate:
parts of the body - 60-100 bpm
- Influenced by the sympathetic and
parasympathetic nervous system
The valves:
Pulse Scale:
Atrioventricular- between atria and the ventricles
(Tricuspid and Bicuspid) 0- Not palpable
Semilunar- located in the aorta and in the trunk +1- weak thready, obliterated with pressure
(Aortic and Pulmonary valve)
+2- diminished pulse, cannot be obliterated
The valves and the Heart sound:
+3- easy to palpate, full pulse cannot be obliterated
S1 and S2- high pitch
+4- strong, bounding pulse; may be abnormal
- Avoid when hyperkalemia, ace inhibitor,
arbs medication
Blood pressure:
Potassium-wasting- Furosemide (Lasix);
- 120/80 mmhg Bumetanide (Bumex); Mannitol; Diuril
(Chlorothiazied)
Regulated by: - Eat potassium rich food (potato, apricot,
Nervous system banana, orange, watermelon, strawberry)
ADH/ vasopressin Beta- Blockers:
RAA mechanism
- Blocks beta receptors in the heart causing:
Prehypertension- 120- 139/ 80-89 decrease heart rate, force of contraction, rate
Stage 1 hypertension- 140-159/90-99 of A-V conduction
Area of Ischemia- viability may not be damaged as long Myoglobin- Normal:0-80 ng/ml
as MI doesn’t extend and collateral circulation is able to
- Early marker but not cardiac specific; rules
compensate.
out early diagnosis of MI
- Causes depressed S-T segment. - Elevate: 1-3 hrs; Peak: 4-12 hrs; Normalize:
24 hrs
S/Sx:
Creatinine Kinase- has 3 isoenzymes; cardiac
Chest pain with radiation- sudden, substernal, specific
crushing, tightness, severe, unrelieved by Nitro
Dyspnea - Elevate: 4-8 hrs; Peak 18 hrs; Normalize 48-
Pallor 72 hrs
Restlessness (Primary presenting S/sx) Troponin- Normal: I: <0.6 ng/ml; T: <0.2 ng/ml
Anxiety
Diaphoresis - Used for early and late diagnosis
Nausea and vomiting - 3 proteins
S4 and dysrhythmias - Cardiac specific
- Elevate: 4-8 hrs; Peak: 12- 24 hrs;
Pain Assessment: Normalize: 1 wk
Precipitating factor Nx Management:
Intensive care for first 48hrs Sinus Bradycardia- <60 bpm; pattern similar to NSR
Bed rest for first 12 hrs
- Treated only if symptomatic
O2 by nasal cannula at 2-5 L/min
Liquid diet for the first 4-12 hrs Management: Administer atropine, prepare for
Small, frequent feedings are often recommended transcutaneous pacemaker
Arrhythmias
Heart Failure Pacemaker Client education:
Cardiogenic shock
Dressler’s syndrome- cause pericarditis (fever, Wear medic alert
pleuritic pain and pericardial effusion) Avoid applying pressure over device
Report fever, redness, swelling or soreness at
implantation site
CARDIAC DYSRHYTHMIA- Report persistent hiccupping
Avoid contact sports
Properties of the heart: Wear loose fitting
Automaticm- ability to initiate electric impulse Report signs of infection
Conductibility- ability to transmit an electrical Lie down if he feels a shock
impulse from one cell to another Avoid electromagnetic field
Excitability- ability to respond to an electrical Restriction on activities
impulse
Refractoriness- cardiac muscle cannot be
excited during whole period of systole and early HEART FAILURE- inability of the heart to maintain
part of diastole. This period prevents waves adequate CO to meet the metabolic needs of the body
summation and tetanus because of impaired pumping action
Contractility- ability of the cardiac muscle to
Left sided- symptoms are pulmonary
contract
S/Sx: Paroxysmal nocturnal dyspnea, elevated pulmonary Place in High fowler’s position
capillary wedge pressure, blood-tinged sputum, cough, Oxygenate in high concentrations
orthopnea, exertional dyspnea, cyanosis Suction as needed
Treatment: Monitor VS
Administer Medication
Morphine Rotating Tourniquet
Aminophylline Monitor I and O
Digoxin
Diuretics
Oxygen
Gasses
Right sided HF
S/Sx: Dependent edema, Jugular vein distention,
Abdominal distention, Hepatomegaly, Splenomegaly,
Nocturnal Diuresis, Hepatojugular reflex
Hemodynamic monitoring:
Central Venous pressure- Normal: 0-8 mmhg