Member since: April 2011
What is the relationship of the kidneys to the cardiovascular system?
Chest discomfort or pain that occurs when the myocardial oxygen demands exceed supply and is relieved by rest.
ECG: ST depression and T wave inversion.
During an attack:
Teach that sexual activity may be resumed after exercise is tolerated, usually when able to climb 2 flights of stairs without exertion. Nitro can be taken prophylactically before intercourse.
Which meds would be appropriate for acute angina?
Disruption in or deficiency of coronary artery blood supply, resulting in necrosis of myocardial tissue.
For pain and to increase O2 perfusion, IV morphine sulfate (acts as a peripheral vasodilator and decreases venous return). Bed rest for 24 hours.
BP equal to or greater than 140/90 on two separate occasions.
BP is created by the difference in the pressure of the blood as it leaves the heart and the resistance it meets flowing out to the tissues. Any factor that alters cardiac output or peripheral vascular resistance will alter BP.
Risk factors for HTN: heredity, race, age, alcohol abuse, increased salt intake, obesity, and use of oral contraceptives.
The number one cause of a CVA in hypertensive clients is noncompliance with medication regime. HTN is often symptomless, and antiHTN meds are expensive and have SE. Teaching is important.
Peripheral Vascular Disease (PVD)
Decreased blood flow results in diminished sensation in the lower extremities. Any heat source can cause severe burns before the client realizes the damage is being done.
A client is admitted with severe chest pain and states that he feels a terrible tearing sensation in his chest. He is diagnosed with a dissecting aortic aneurysm. What assessments should the nurse obtain in the first few hours?
During aortic aneurysm repair, the large arteries are clamped for a period of time, and kidney damage can result. Monitor daily BUN and creatinine levels. Normal BUN is 10-20 mg/dl and normal creatinine is 0.2-1-2 mg/dl. The ratio of BUN to creatinine is 20:1. When this ration increases or decreases, suspect renal problems.
a positive Homan’s sign is considered early indication of thrombophlebitis. However, it may also indicate muscle inflammation. If a DVT has been confirmed, don’t do Homan’s.
Heparin prevents conversion of fibrinogen to fibrin and prothombin to thrombin, inhibiting clot formation. Do not massage area or aspirate; give in the abdomen between the pelvic bones, 2 inches from the umbilicus.
A holter monitor offers continuous observation of client’s heart rate. Teach client to keep a record of: medication times and doses, chest pain episodes: type and duration, valsalva maneuver (straining at stool, sneezing, coughing), sexual activity, and exercise.
Cardioversion is the delivery of synchronized electrical shocks to the myocardium.
Determine serum electrolyte levels, esp. K and Mg (alcoholics)
Difference in synchronous and asynchronous pacemakers:
Restricting sodium reduces salt and water retention, thereby reducing vascular volume and preload
Infective endocarditis damage to heart valves occurs with the growth of vegetative lesions on valve leaflets. These lesions pose a risk for embolization; erosion or perforation of the valve leaflets; or abscesses within adjacent myocardial tissue. Valvular stenosis or regurgitation (insufficiency), most commonly of the mitral valve, can occur, depending upon the type of damage inflicted by the lesions, and can lead to symptoms of left- or right-sided heart failure.
There are two types of infective endocarditis: acute, which often affects individuals with previously normal hearts and healthy valves and carries a high mortality rate; and subacute, which typically affects individual with preexisting conditions, such as rheumatic heart disease, mitral valve prolapse, or immunosuppression. IV drug users are at risk for both. When this population develops subacute infective endocarditis, the valves on the r side of the heart (tricuspid and pulmonic) are typically affected because of the introduction of common pathogens that colonize the skin into the venous system.
The presence of a friction rub is an indication of percarditis (inflammation of the lining of the heart). ST segment elevation and T wave inversion are also signs of pericarditis.
In mitral valve stenosis, blood is regurgitated back into the left atrium from the left ventricle. In the early period, there may be no symptoms: but as the disease progresses, the client will exhibit excessive fatigue, dyspnea on exertion, orthopnea, dry cough, hemoptysis, or pulmonary edema. There will be a rumbling apical diastolic murmur, and atrial fibrillation is common.