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Cardiovascular

9 Decreased TP in heart Æ Ischemia(Angina) {r necrosis (MI){irreversible}[pathologic Qwave/permanent in the ECG]

9 Eating a heavy meal, strenuous exercise,sex, exposure to cold Æ Decreased bloodflow (heart)Æ decreased TP (heart)Ædecreased O2 (heart)Æ anaerobicrespiration Æ production of lactic acid ÆPAIN Æ management decreased O2demand by rest and SFF

9 Anginao Pain relieved by rest and NTGo NTG

ƒ Vasodilation Æ orthostatic hypotentionÆ move gradually Æ Monitor BP

ƒ Store in a dark and amber containerƒ Effective Æ tingling sensation Æ no

need to notify physicianƒ Maximum of 3 tablets with 5 minute

interval9 MI

o Pain relieved by Morphine SO4ƒ Narcotic analgesicƒ Can cause respiratory depression Æ

monitor RR and O2 saturationƒ Antidote Æ narcan

9 Cardioversion Æ synchronous9 Defibrillation Æ unsynchronous9 Buerger’s disease Æ CS Æ

vasoconstriction Æ stop CS Æ common inmen

9 Raynaud’s Æ stress and cold Ævasoconstriction Æ common in female

9 Congestive heart failureo Left sided Æ pulmonary

ƒ Dyspneaƒ Cracklesƒ Polycythemia Æ due to decrease O2 to

the kidneysƒ Clubbing of the fingers Æ due toprolonged hyxiaƒ Orthopneao Right sided Æ systemicƒ Hepatomegalyƒ Distended neck veinsƒ Edema

Philippians 4:6 - “…do not be anxiousabout anything, but in everything byprayer and supplication withthanksgiving let your requests be madeknown to God.”

ƒ Portal hypertensionƒ Ascites Æ weight gainƒ Varicose veins

o Digoxinƒ Cardiac glycosideƒ Positive inotrophic effect Æ increased

strength of myocardial contractionƒ Negative chronotrophic effect Æ

decreased cardiac rate Æ monitor CRÆ never give if CR below 60 bpm

ƒ Adverse effect V – omitting A – norexia N – ausea D – iarrhea A – bdominal pain REMEMBER: earliest Æ GI; late

Æ halo vision Antidote Æ Digibind

9 Decreased RBC Activity in tolerance,Fatigue, provide rest, Anemia

9 Decreased Platelets Prone to bleeding,avoid parenteral injection, applypressure on injection site, high risk forinjury

9 Decreased WBC prone to infection,reverse isolation

9 Increased WBC presence of infection9 First Day/Newly diagnosed Knowledge

deficit

9 Heparin Æ anticoagulant Æ preventfurther enlargement of clot not dissolvethem Æ monitor APTT/PTT Æ antidoteprotamine SO4

9 Coumadin Æ anticoagulant Æ preventfurther enlargement of clot not dissolve itÆ monitor PT Æ vitamin K is the antidote

9 Urokinase/Streptoase dissolves theclot9 Lidocaine with Epinephrine whencombine has a very low pH and is,therefore very painful when injected.However, the pain can be minimized bybuffering the solution with sodiumbicarbonate, and by giving theinjection subdermally at a very slowrate.

NURSING FACTS IN BRIEFCARDIOVASCULAR CONDITIONS

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250 - 2 -

9 Epinephrine is added to localanesthesia to increase the duration.However, epinephrine causesvasoconstriction and decreasedbleeding, which weakens tissuedefenses and increases the incidence ofwound infection.

9 Acute aortic dissection has a physicalsigns and symptoms such as BPdifferences between arms and or legs,cardiac tamponade, and aorticinsufficiency murmur

9 Common side effect of beta blockers isfatigue, which occurs early in thetreatment and depression which occurslater.

9 Most common cause of death within thefirst few hours following an MI isCardiac Arrhytmias generallyVentricular Fibrillaton.

1. What type of abnormal cardiac rhythmcan be slowed through Valsalvamaneuvers and/or carotid massage?

Æ Supraventricular rhythms

2. Name some common Valsalva maneuvers.

ÆHolding the breath, stimulation of the gagreflex, ipecac, squatting, pressure on theeyeball, or immersing the face in ice

3. What is the common side effect of b-blockers?

Æ Fatigue, which occurs early in treatment:and depression, which occurs later.

4. What is the most common cause of deathwithin the first few hours following anMI?

Æ Cardiac dysrhythmias, generally V-fib

5. What are the ECG findings on a patientwith hypokalemia?

ÆFlattened T-waves, depressed ST segments,prominent P-waves, prominent U-waves, andprolonged QT and PR intervals

6. What are the ECG findings on a patientwith hyperkalemia?Æ Peaked T-waves, prolonged QT and PRintervals, diminished P-waves, depressed T-waves, QRS widening levels exceeding 10mEq/L, and a classic sine wave.

7. What is the first ECG finding for a patientwith hyperkalemia?

Æ The development of tall-peaked T-waves atlevels of 5.6-6.0 mEq/L, which are best seenin the precordial leads

8. During the first hours after a myocardialinfarction, why is it important to monitorthe patient’s ECG?

Æ Arrhythmias are the leading cause of deathfollowing an infarct

9. Why should you count a patient’s apicalpulse before administering digitalis?

Æ A symptom of digitalis toxicity is a slowpulse.

Notes:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________“To believe in yourself and to follow your dreams,to have goals in life and a drive to succeed, and tosurround yourself with the things and the peoplethat make you happy - this is success!”