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Heart infections
A. Pericarditis
1. Definition and related terms
a. in pericarditis, an infection (from a bacterium, a fungus, Systemic Lupus
Erythematosus (SLE), etc.) inflames the pericardium.
b. there may or may not be pericardial effusion or constrictive pericarditis.
c. dressler's Syndrome, also called postmyocardial infarction syndrome, is a
combination of pericarditis, pericardial effusion and constrictive pericarditis. It
occurs several weeks to months after a myocardial infarction. Etiology unclear.
2. Epidemiology
a. may be acute or chronic and may occur at any age.
b. pericarditis occurs in up to 15% of persons with a transmural infarction.
3. Findings
a. sharp chest pain often relieved by leaning forward
b. pericardial friction rub
c. dyspnea
d. fever, sweating, chills
e. dysrhythmias
f. pulsus paradoxus
g. client cannot lie flat without pain or dyspnea
4. Management
a. antibiotics to treat underlying infection
b. corticosteroids: usually reserved for clients with pericarditis due to SLE, or
clients who do not respond to NSAID
c. NSAIDS/Asprin for pain and inflammation
d. oxygen: to prevent tissue hypoxia
e. surgical
I. emergency pericardiocentesis if cardiac tamponade develops
II. for recurrent constrictive pericarditis, partial pericardiectomy
(pericardial window) or total pericardiectomy
5. Nursing interventions
a. manage pain and anxiety
b. the cardio-care six
c. maintain a pericardiocentesis set at the bedside in case of cardiac tamponade.
d. assess respiratory, cardiovascular, and renal status often.
e. observe for findings of infiltration or inflammation at the venipuncture site, a
possible complication of long-term IV administration. Rotate the IV sites often.
f. client and family teaching - teach the cardio five
6. Diagnostic studies
a. EKG changes, arrythmias
b. echocardiography to determine pericardial efusion or cardiac tamponade
c. history and physical exam
B. Myocarditis
2. Definition - an inflammatory condition of the myocardium caused by
a. viral infection
b. bacterial infection
c. fungal infection
d. serum sickness
e. rheumatic fever
f. chemical agent
g. as a complication of a collagen disease, i.e. SLE
3. Epidemiology
a. may be acute or chronic and may occur at any age.
b. usually an acute virus and self-limited, but it may lead to acute heart failure.
4. Findings
a. depends on the type of infection, degree of myocardial damage, capacity of
myocardium to recover, and host resistance
b. may be minor or unnoticed: fatigue and dyspnea, palpitations, occasional
precordial discomfort manifested as a mild chest soreness and persistent fever
c. recent upper-respiratory infection with fever, viral pharyngitis, or tonsillitis
d. cardiac enlargement
e. abnormal heart sounds: murmur, S3 or S4 or friction rub
f. possibly findings of congestive heart failure such as pulsus alternans, dyspnea,
and crackles
g. tachycardia disproportionate to the degree of fever
5. Diagnostic studies
a. EKG for changes and arrythmias
b. labs
I. increases ESR
II. increases myocardial enzymes such as:
I. AST
II. CK
III. LDH
c. endomyocardial biopsy (EMB)
d. myocardial imaging
6. Management
a. antibiotics to treat underlying infection
b. corticosteroids to decrease inflammation
c. analgesics for pain
d. oxygen to prevent tissue hypoxia
7. Nursing interventions
a. the cardio-care six with modified bedrest and less help with ADLs
b. assess for edema; weigh daily; record intake and output
c. assess cardiovascular status frequently
d. observe for findings of left-sided heart failure (dyspnea, hypotension and
tachycardia)
e. check often for changes in cardiac rhythm or conduction; auscultate heart
sounds
f. evaluate arterial blood gas levels as needed to ensure adequate oxygenation
g. client and family teaching
I. physical activity may be slowly increased to sitting in chair, walking
in room, then outdoors.
II. avoid pregnancy, alcohol, and competitive sports.
III. immunize against infections.
IV. teach client about anti-infective drugs. Stress importance of taking
drugs as ordered.
V. teach clients taking digitalis at home to:
I. check pulse for one full minute before taking the dose, and
withhold the drug if heart rate falls below 60 beats/minute.
II. observe for findings of digitalis toxicity (anorexia, nausea,
vomiting, blurred vision, cardiac arrhythmias) and for
factors that may increase toxicity, such as electrolyte
imbalance and hypoxia.
VI. teach client to report rapidly beating heart.
C. Endocarditis
2. Definition and related terms
a. an infection of the endocardium, heart valves, or cardiac prosthesis resulting
from bacterial or fungal invasion.
b. endocarditis can be classified as
I. native valve endocarditis
II. endocarditis in I.V. drug users
III. prosthetic valve endocarditis
3. Epidemiology
a. with proper treatment about 70% of clients recover.
b. the prognosis is worse when endocarditis damages valves severely or involves
a prosthetic valve.
c. infective endocarditis occurs in 50 to 60% of clients with previous valvular
disorders.
d. systemic lupus erythematosus (SLE) often leads to nonbacterial endocarditis.
e. in 12% to 35% of clients with subacute endocarditis, lesions produce clots that
show the findings of splenic, renal, cerebral or pulmonary infarction, or
peripheral vascular occlusion.
4. Findings of endocarditis
a. cardiac murmurs in 85 to 90% of clients
b. fever
c. especially, a murmur that changes suddenly, or a new murmur that develops in
the presence of a fever
d. pericardial friction rub
e. anorexia
f. malaise
g. clubbing of fingers
h. neurologic sequelae of embolus
i. petechiae of the skin (especially on the chest)
j. splinter hemorrhage under the nails
k. infarction of spleen: pain in the upper left quadrant, radiating to the left
shoulder, and abdominal rigidity
l. infarction in kidney: hematuria, pyuria, flank pain, and decreased urine output
m. infarction in brain: hemiparesis, aphasia, and other neurologic deficits
n. infarction in lung: cough, pleuritic pain, pleural friction rub, dyspnea and
hemoptysis
o. peripheral vascular occlusion: numbness and tingling in an arm, leg, finger,
or toe, or signs of impending peripheral gangrene
5. Management - clients at risk for prosthetic valves
a. prophylaxis - to prevent endocarditis; i.e. MVP, cardiac lesions
b. antibiotics - to treat underlying infection
c. antipyretics - to control fever
d. anticoagulants - to prevent embolization
e. oxygen - to prevent tissue hypoxia
f. surgical - possible valve replacement
6. Nursing interventions
a. the cardio-care six
b. observe for findings of infiltration or inflammation at venipuncture site; rotate
sites often.
c. client and family teaching
I. explain all procedures in a simple and culturally sensitive manner.
II. involve the client and family in scheduling the daily routine
activities. Allow client and family to participate in care.
III. teach client relaxation techniques (meditation, visualization, or
guided imagery) to cope with stress, pain, or insomnia.
IV. explain endocarditis and the need for long-term therapy.
V. explain the need for prophylactic antibiotics before dental work and
other invasive procedures.
VI. teach client to report fever, tachycardia, dyspnea and shortness of
breath.
7. Diagnostic studies
a. health history
b. lab data
I. CBC
II. blood cultures
III. ESR
c. CXR - to detect CHF
d. EKG - transesophageal echocardiogram to detect vegetation and abscess on
valves
D. Rheumatic heart disease (rheumatic endocarditis)
2. Definition and related terms
a. rheumatic heart disease is damage to the heart by one or more episodes of
rheumatic fever. Pathogen is a group A streptococci.
b. rheumatic endocarditis is damage to the heart, particularly the valves, resulting
in valve leakage (regurgitation) and/or stenosis. To compensate, the heart's
chambers enlarge and walls thicken.
3. Epidemiology
a. worldwide, 15 to 20 million new cases of rheumatic fever are reported each
year.
b. rheumatic fever follows a group A streptococcal infection. We could prevent it
by finding and treating streptococcal pharyngitis.
c. where malnutrition and crowded living are common, rheumatic fever is
commonest in children between ages 5 and 15.
d. rheumatic fever strikes most often during cool, damp weather. In the U.S., it is
most common in the northern states.
e. it is unknown how and why group A streptococcal infections cause the lesions
called Aschoff bodies.
f. damage depends on site of infection: most often the mitral valve in females and
the aortic valve in males.
g. malfunction of these valves leads to severe pericarditis, and sometimes
pericardial effusion and fatal heart failure. Of those who survive this
complication, about 20% die within ten years.
4. Findings
a. streptococcal pharyngitis
I. sudden sore throat
II. throat reddened with exudate
III. swollen, tender lymph nodes at angle of jaw
IV. headache and fever to 104 degrees Fahrenheit
b. polyarthritis manifested by warm and swollen joints
c. carditis
d. chorea
e. erythema marginatum (wavy, thin red-line rash on trunk and extremities)
f. subcutaneous nodules
g. fever to 104 degrees Fahrenheit
h. heart murmurs pericardial friction rub and pericardial rub
i. no lab test confirms rheumatic fever, but some support the diagnosis.
5. Management
a. give antibiotics steadily to maintain level in blood.
b. provide analgesics - for pain/inflammation
c. oxygen to prevent tissue hypoxia.
d. surgical - commissurotomy, valvuloplasty, prosthetic heart valve
6. Nursing interventions
a. the cardio-care six
b. help the client with chorea to grasp objects; prevent falls.
c. encourage family and friends to spend time with client and fight boredom
during the long, tedious convalescence.
d. client and family teaching
I. explain all tests and treatments
II. nutrition
III. hygienic practices
IV. to resume ADLs slowly and schedule rest periods
V. to report penicillin reaction: rash, fever, chills
VI. to report findings of streptococcal infection
I. sudden sore throat
II. diffuse throat redness and oropharyngeal exudate
III. swollen and tender cervical lymph glands
IV. pain on swallowing
V. temperature of 101 to 104 degree Fahrenheit
VI. headache
VII. nausea
VII. keep client away from people with respiratory infections
VIII. explain necessity of long-term antibiotics
IX. arrange for a visiting nurse if necessary
X. help the family and client cope with temporary chorea
7. Diagnostic studies
a. antistreptolysin 0 titer - increased
b. ESR - increased
c. throat culture - positive for streptococci
d. WBC count - increased
e. RBC parameters - normocytic, normochromic anemia
f. C-reactive protein - positive for streptococci
A. Mitral stenosis
1. Definition - mitral valve thickens and gets narrower, blocking blood flow from the left
atrium to left ventricle.
b. physiology (illustration )
i. function of the heart is the transport of oxygen, carbon
dioxide, nutrients and waste products
ii. cardiac cycle consists of: (illustration )
• systole - the phase of contraction during which
the chambers eject blood
• diastole - the phase of relaxation during which
the chambers fill with blood. When heart pumps,
myocardial layer contracts and relaxes.
iii. blood flow: (illustration 1 illustration 2 )
• deoxygenated blood enters the right atrium
through the superior and inferior vena cava
• enters the right ventricle via the tricuspid valve
• travels through the pulmonic valve to pulmonary
arteries and lungs
• oxygenated blood returns from lungs through the
pulmonary veins into left atrium and enters the
left ventricle via bicuspid (mitral) valve.
• from the left ventricle, through the aortic valve
through the aorta to the systemic circulation
iv. the heart itself is supplied with blood by the left and right
coronary arteries (illustration )
v. the vascular system is a continuous network of blood
vessels.
• the arterial system consists of arteries, arterioles
and capillaries and delivers oxygenated blood to
tissues
• oxygen, nutrients and metabolic waste are
exchanged at the microscopic level
• the venous system, veins and venules, returns the
blood to the heart (illustration )
2. Epidemiology
3. Findings
a. mild - no findings
b. moderate to severe
i. dyspnea on exertion
ii. paroxysmal nocturnal dyspnea
iii. orthopnea
iv. weakness, fatigue, and palpitations
c. peripheral and facial cyanosis in severe cases
d. jugular vein distention
e. with severe pulmonary hypertension or tricuspid stenosis - ascites
f. edema
g. hepatomegaly
h. diastolic thrill at the cardiac apex
i. when client lies on left side, loud S1 or opening snap and a diastolic murmur at
the apex
j. crackles in lungs
4. Management
a. antiarrhythmics if needed
b. if medication fails, atrial fibrillation is treated with cardioversion.
c. low-sodium diet - to prevent fluid retention
d. oxygen if needed - to prevent hypoxia
e. surgery - mitral commissurotomy or valvotomy
5. Nursing interventions
a. the cardio-care six
b. observe closely for findings of heart failure, pulmonary edema, and reactions to
drug therapy.
c. if client has had surgery, watch for hypotension, arrhythmias, and thrombus
formation.
d. monitor the cardio seven
e. client and family
i. explain the need for long-term antibiotic therapy and the need for
additional antibiotics before dental care.
ii. report early findings of heart failure such as dyspnea or a hacking,
nonproductive cough.
6. Diagnostic studies/findings
a. history and physical exam
b. EKG- for changes of left atrial enlargement and right ventricle enlargement
c. echocardiogram - for restricted movement of the mitral valves and diastolic
turbulance
B. Mitral insufficiency (or regurgitation)
3. Definition and related terms
a. a damaged mitral valve allows blood from the left ventricle to flow back into
the left atrium during systole.
b. to handle the backflow, the atrium enlarges. So does the left ventricle, in part to
make up for its lower output of blood.
4. Epidemiology
a. follows birth defects such as transposition of the great arteries.
b. in older clients, the mitral annulus may have become calcified.
c. cause unknown; may be linked to a degenerative process.
d. occurs in 5 to 10% of adults.
5. Findings
a. client may be asymptomatic
b. orthopnea, dyspnea, fatigue, weakness, weight loss
c. chest pain and palpitations
d. jugular vein distention
e. peripheral edema
6. Management
a. low-sodium diet - to prevent fluid retention
b. oxygen as needed - to prevent tissue hypoxia
c. antibiotics - to treat infection
d. prophylactic antibiotics - to prevent infection
e. surgery - mitral valvuloplasty or valve replacement
7. Nursing interventions
a. the cardio-care six
b. monitor the cardio seven
c. monitor for left-sided heart failure, pulmonary edema, adverse reactions to drug
therapy, and cardiac dysrhythmias especially atrial and ventricular fibrillation
d. if client has surgery, monitor postoperatively for hypotension, arrhythmias and
thrombus formation
e. client and family teaching
i. diet restrictions and drugs
ii. explain tests and treatments
iii. prepare client for long-term antibiotic and follow-up care.
iv. stress the need for prophylactic antibiotics during dental care.
v. teach client and family to report findings of heart failure:
dyspnea and hacking, nonproductive cough.
8. Diagnostic findings
a. EKG for arrythmias and changes of left atrial enlargement
b. echocardiogram - to visualize regurgitant jets and flail chordae/leaflets
c. cardiac cath shows regurgitation of blood from left ventricle to left atrium
C. Tricuspid stenosis
3. Definition: narrowing of the tricuspid valve between right atrium and right ventricle
4. Epidemiology
a. relatively uncommon
b. usually associated with lesions of other valves
c. caused by rheumatic fever
5. Findings
a. dyspnea, fatigue, weakness, syncope
b. peripheral edema
c. jaundice with severe peripheral edema and ascites can mean that tricuspid
stenosis has led to right ventricular failure
d. may appear malnourished
e. distended jugular vein
6. Management: surgery - valvulotomy or valve replacement; valvuloplasty
7. Nursing interventions
a. the cardio-care six
b. monitor the cardio seven
c. monitor for findings of heart failure, pulmonary edema, and adverse reactions
to the drug therapy
d. post valve surgery, monitor client for hypotension, arrhythmias and thrombus
formation
e. when client sits, elevate legs - to prevent dependent edema
f. client and family teaching
i. teach the cardio five
ii. client must comply with long-term antibiotic and follow up care
iii. emphasize the need for prophylactic antibiotics during dental care
8. Diagnostic findings
a. EKG - for arrythmias
b. echocardiogram - right ventricular dilation
and paradoxic septal motion
A. Hypertension (illustration )
1. Definitions
a. hypertension - systolic blood pressure of 140 mm Hg or greater, diastolic blood
pressure of 90 mm Hg or greater, or taking antihypertensive medication
b. chronic hypertension of pregnancy - high blood pressure already present before
week 20 of gestation
c. accelerated hypertension - a hypertensive crisis: blood pressure rises very
rapidly, threatening the brain
3. Findings
a. may be asymptomatic
b. findings reflect the effect of hypertension on organ systems
c. occipital headache, blurred vision, dizziness
d. dizziness, palpitations, weakness, fatigue, and impotence
e. nosebleeds
f. bloody urine
g. chest pain and dyspnea, if heart is involved
4. Diagnosis
a. based on the average of two or more blood pressure readings, two minutes
apart, at each of two or more visits after an initial screening visit
b. classification of adult hypertension
5. Management
a. pharmacological
i. initial therapy - for uncomplicated hypertension, it is recommended
to start with a diuretic or Beta-adrenergic blocking agent
ii. oxygen PRN in acute crisis
iii. angiotensin-converting enzyme (ACE) inhibitors are used to treat
left-sided heart failure and preferred if client is diabetic
iv. antilipemics
b. goals of treatment
i. BP <130/85 mm Hg
ii. control dyslipidemia, obesity, inactivity
iii. control diabetes mellitus, if indicated
6. Nursing interventions: reinforce client and family teaching regarding:
a. client to use self-monitoring blood pressure cuff
b. client to record readings at least twice weekly in a journal or calendar for
review by care provider during visits
c. client to set up routine for taking antihypertensive medications
d. the need to warn against high-sodium antacids, and cold or sinus remedies with
vasoconstrictors such as antihistamines
e. diet low in sodium, cholesterol and saturated fat
f. when client is to report extremely high blood pressure readings
g. lifestyle modifications
i. optimize body weight
ii. drink alcohol based on current guidelines
iii. moderate dietary sodium (two gm sodium diet)
iv. exercise: regular moderately intense aerobic activity
v. avoid tobacco products
vi. manage stress triggers and responses to triggers
B. Coronary artery disease (illustration )
5. Definition - fatty deposits in coronary arteries (atheroma or plaque) narrow the artery (by
75% or more) and cut flow of blood and oxygen to the heart muscle.
6. Epidemiology and etiology
a. CAD is epidemic in the western world.
b. more than 30% of men age 60 or older show signs of CAD on autopsy.
c. most common cause: Atherosclerosis
d. risk factors:
i. over 40 white male
ii. family history of CAD
iii. high blood pressure
iv. high cholesterol
v. smokers are twice as likely to have a myocardial infarction and four
times as likely to die suddenly. The risk drops sharply within one year
after smoking ceases.
vi. obesity (waist predominance); [added weight increases the risk of
diabetes, hypertension and high cholesterol]
vii. sedentary life style
7. Findings: angina
8. Management
a. pharmacology
i. nitrates such as nitroglycerin, isosorbide dinitrate (Isordil), or beta-
adrenergic neuron-blocking agents
ii. oxygen - to prevent hypoxia
iii. diuretics and beta-adrenergic blocking agents
iv. aspirin - decreases platelet aggregation
v. antilipemics - to decrease circulating lipids
b. diet: reduce calories, salts, fats, cholesterol
c. cardiac catheterization
i. after cardiac catheterization and percutaneous transluminal coronary
angioplasty (PTCA), maintain heparinization; observe for bleeding
systemically at the site, and keep the affected leg straight and
immobile for six to 12 hours.
ii. check for distal pulses.
iii. to counter the diuretic effect of the dye, increase IV fluids and make
sure client drinks plenty of fluids.
iv. assess potassium level- observe for dysrhythmias
v. observe findings of hypotension, bradycardia, diaphoresis, dizziness;
give atropine and lay the client flat.
d. rotational ablation
i. after rotational ablation, monitor the client for chest pain,
hypotension, coronary artery spasm and bleeding from the catheter
site.
ii. provide heparin and antibiotic therapy for 24 to 48 hours or as
ordered.
e. laser coronary angioplasty
f. surgical treatment - coronary artery bypass graft (CABG
9. Nursing interventions
a. help client with ADL (activities of daily living)
b. partial bed rest
c. reassure client
d. assist with turning, deep breathing and coughing exercises
e. relieve chest pain by oxygen and medication as ordered
f. during angina attacks, monitor bp, heart rate, pain, meds, symptoms; get
electrocardiogram
g. keep nitroglycerin available for immediate use
h. client and family teaching
i. risks
I. teach the risk factors for CAD (coronary artery disease)
II. encourage client to lose excess weight; review low-fat,
low-cholesterol diet
III. teach smoking cessation
IV. teach side effects of drugs for CAD
V. stress - teach stress reduction techniques
ii. avoid
I. activities known to cause angina
II. physical activities for two hours after meals
III. very cold and very hot weather
IV. alcohol and caffeine drinks
V. diet pills, nasal decongestants, or any remedy that can raise
heart rate or blood pressure
iii. use
I. nitroglycerin tablets; carry at all times
II. if necessary nitroglycerin patch
iv. report
I. angina
II. angina >15 minutes, go to clinic or hospital
C. Shock
5. Definition - body cells need more oxygen than blood is supplying. cells and then organs
fail. shock has many different causes. It is a medical emergency.
6. Five types of shock:
a. cardiogenic
b. septic
c. neurogenic
d. anaphylactic
e. hypovolemic
ii. diagnostics
iii. management - objective: to correct underlying
cause and prevent progression
• cardiogenic shock
o pharmacologic
treatments
positive inotropic
agents: increase
myocardial
contractility and
improve systolic
ejection:
dobutamine
(Dobutrex),
amrinone lactate
(Inocor)
vasodilators:
improve heart's
pumping action by
reducing its
workload:
nitroglycerin
(Corobid),
nitroprusside
sodium (Nipride),
(Usually limited to
clients with failing
ventricular
function)
vasopressors:
increase peripheral
vascular resistance
and elevate blood
pressure:
norepinephrine
(Levophed),
dopamine
hydrochloride
(Intropin)
oxygen therapy
o surgical treatments
intra-aortic balloon
counterpulsation
left and right
ventricular assist
pumping
heart transplant
A. Dysrhythmias
1. Definition: disturbance in heart rate or rhythm
2. Types of dysrhythmia
a. supraventricular: sinus, atrial, and junctional
i. sinus tachycardia
ii. sinus bradycardia
iii. sinus arrhythmia
iv. premature atrial complexes
v. atrial tachycardia
vi. atrial flutter
vii. atrial fibrillation
viii. premature junctional complex
ix. junctional tachycardia
b. ventricular
i. premature ventricular contraction
ii. ventricular tachycardia
iii. ventricular fibrillation
iv. asystole
v. atrioventricular block:
vi. first degree A-V block (no treatment)
vii. second degree A-V block (no treatment)
viii. third degree A-V block
c. Nursing interventions
i. supraventricular dysrhythmias
A. asymptomatic - no nursing interventions indicated
B. symptomatic
A. administer medications as ordered
B. provide emotional support
C. teach client
A. medications and side effects
B. to wear dysrhythmia identification jewelry
ii. ventricular dysrhythmias
A. administer medications as ordered
B. monitor
C. monitor hemodynamic indicators as ordered
D. administer oxygen as ordered
E. provide a restful environment
F. prepare the client for cardioversion
G. initiate cardiopulmonary resuscitation as indicated
H. provide emotional support
I. teach client
A. medications and side effects
B. importance of dysrhythmia identification jewelry
iii. atrio-ventricular (AV) conduction disturbances
A. asymptomatic: no nursing interventions indicated
B. symptomatic
A. administer medications as ordered
B. prepare client for pacemaker insertion
C. care of the client undergoing surgery
D. provide emotional support
E. provide a restful environment
3. Aneurysms
a. Definition, four types, two locations
i. dilation of an artery due to a weakness in the arterial wall
ii. four types of aneurysms
A. saccular: outpouching of one wall in a circumscribed area
B. fusiform: involves complete circumference of artery
C. dissecting: accumulation of blood separating the layers of the arterial
wall
D. pseudoaneurysm: tear of the full thickness of the arterial wall, leading
to a collection of blood contained in the connective tissue
iii. two locations: abdominal aorta and thoracic aorta
A. location one: abdominal aortic aneurysm
A. findings of abdominal aortic aneurysm
A. usually asymptomatic
B. vague abdominal or back pain
C. tenderness on palpation
D. hypotension
E. diminished pulses in lower extremities
F. commonest site: just below renal arteries and
above iliac arteries
B. treatment - surgical repair
C. nursing interventions
A.
care of the client undergoing surgery
B.
after surgery, watch for back pain, a sign of retroperitoneal
hemorrhage
C. monitor perfusion
D. provide comfort measures
E. provide emotional support
F. teach client - to avoid prolonged sitting and lifting of heavy
objects
iv. location two: thoracic aortic aneurysm
A. findings of thoracic aortic aneurysm
A. may be asymptomatic
B. vague chest pain
C. dyspnea
D. distended neck veins
B. management - surgical repair
C. nursing interventions
A. care of the client undergoing surgery
B. care of the client undergoing cardiac surgery
b. Etiology - atherosclerosis
c. management
i. pharmacologic
• anticoagulants - to prevent blood clots
• vasodilators
• antiplatelet drugs - to prevent platelet aggregation
• pentoxifylline (Trental): increases blood flow by thinning
blood
ii. surgical treatment
• endarterectomy
• femoral-popliteal bypass (illustration )
• sympathectomy
• amputation of affected limb for gangrene
• laser coronary angioplasty (LTA)
• peripheral angioplasty
5. Both acute and chronic arterial occlusive disease
c.nursing interventions
i. administer medications as ordered
ii. monitor peripheral pulses and blanch test
iii. provide comfort measures
iv. help client develop an exercise program
v. care of the client undergoing surgery
vi. provide foot care
vii. teach client
• to change positions frequently
• to avoid crossing legs
• to avoid any constrictive clothing on legs
• to avoid trauma to lower extremities
• foot care
• to place legs in dependent position to increase blood flow
Adrenergic
Adrenergic neuron-blocking agents
Afterload
Angioplasty
Angiotensin-converting enzyme (ACE) inhibitors
Antiarrhythmic
Arterial line
Atherectomy
Auscultatory gap
Automaticity
Bounding pulse
Calcium channel blockers
Cardiac catheterization
Cardiac output
Cholinergic
Conductivity
Coronary Artery Bypass
Depolarization
Echocardiography
Excitability
Hyperlipidemia
Preload
Repolarization
Streptokinase
Stress test
Stroke volume
Tamponade, cardiac
Vasoconstrictors
Vasodilators
• Alveolocapillary membrane
• Aortic Valve
• Bypass
• Cardiac cycle
• Chambers of the heart
• Circulation of blood through heart and major vessels
• Conduction system of the heart
• Coronary arteries (anterior and posterior)
• Normal and diseased coronary arteries
• Pericardicentesis
• Pericardium
• QRST Complex of Electrocardiogram/ECG Leads
• Raynaud's Phenomenon
• Structure of an artery
• Systemic arteries
• Systemic blood pressure
• Ventricular fibrillation
• Ventricular tachycardia
• Varicose Veins