RN/PN Nclex CONCEPT: CARDIOVASCULAR SYSTEM Latest Updated 2022,100% CORRECT

RN/PN Nclex CONCEPT: CARDIOVASCULAR SYSTEM Latest Updated 2022 BLOOD FLOW Imagine in your mind how the blood circulation works. Conduction System & ECG: Sinoatrial Node (SA Node) -this is where the impulse starts It is also known as what? How much firing does it give? Atrioventricular Node (AV Node) “Secondary pacemaker” 40-60bpm It is also called as? Pause for a while to give way for ventricular filling Muscle fibers that creates synchronized contractions NAMING ECG 1. CHECK 5 PARAMETERS, IF NORMAL THEN PLACE THE WORD NORMAL. IF 1 PARAMETER BECOMES ABNORMAL LEAVE IT BLANK 2. CHECK FOR THE ORIGIN OF FIRING: Identify where is the firing coming from? SINUS = ? ATRIAL = ? VENTRICULAR = ? 3. CHECK THE RATE AND RHYTHM 2. Causes: Anti-arrhythmic drugs Sleep Hypothyroidism Management DOC: 1.)ARTIFICIAL PACEMAKER - A pacemaker is inserted into the patient through a simple surgery using either local anesthetic or a general anesthetic PACEMAKER GUIDELINES: 3. Causes: Dehydration, Anemia Shock, Hyperthyroidism Management DOC: Anti-dysrhythmic drug Beta-blockers Calcium Channel Blockers B. ATRIAL RHYTHMS 1. Increase impulse at the atria 250-400bpm Complication Blood stasis ---------- STROKE DOC: Tissue Plasminogen Activator (TPA) Anticoagulant Management: Sodium Channel Blockers - - Cardioversion – Low energy shock What is the purpose of providing Cardioversion to the patient? 2. Increase impulse at the atria 350-400 bpm Manifestations: Complication Blood stasis ---------- STROKE DOC: TPA Anticoagulant Management: Sodium Channel Blockers – Procainamide Quinidine Works best where? Cardioversion NOTE: do cardioversion less than 48hours – with time limit! 3. Increase impulse above the ventricle 150bpm Management DOC: Adenosine Beta – blockers Calcium channel Blockers Cardioversion C. VENTRICULAR RHYTHMS 1. -extra abnormal heart beats in the chambers of the ventricles Management: DOC: Sodium Channel Blocker NOTIFY THE DOCTOR!! *6 or more PVC’s in one minute: this indicates ventricular tachycardia then ventricular fibrillation and then asystole! *3 or more successive PVC’s initial sign of ventricular tachycardia Increase impulse @ ventricles 100bpm Management: 1. If stable, Give 2. If unstable, 3. Defibrillate for pulseless and unconscious start @ then then 3. Fatal decrease CO in 3-5mins Management: ** Epinephrine Lidocaine Magnesium 4. Cardiac standstill - REVIVE THE PATIENT Management: CHECK for responsiveness Ask for help, activate Emergency Medical Services (EMS) / get Automated External Defibrillator (AED) CPR - Compression, Airway, Breathing (C-A-B) Defibrillate Administer Epinephrine to create impulse NOTE IN CPR: *1 cycle is equivalent to how many compressions and rescue breaths? *5 cycles is equivalent to how many minutes of care? Adult ? Child ? Infant? When to stop CPR? ANTIARRYTHMIC DRUGS / ANTIDYSRHYTHMIC DRUGS Provide the name of each drug classification. Group I-A Drugs _ Disopyramide (Norpace) Procainamide (Pronestyl) works best in the Atria Quinidine (Quinaglute) Group I-B Drugs (suppress automaticity in the bundle of His-Purkinje System) Lidocaine (Xylocaine) – works best in the Ventricles Tocainide (Tonocard) Mexiletine (Mexitil) Group I-C (decrease automaticity and conductivity through AV node and ventricles) Flecainide (Tambocor) Propafenone (Rhythmol) Group I Drug (A, B, C) Moricizine (Ethmozine) Group II Drugs Carvedilol – may worsen the patients condition during the initial treatment Atenolol Metoprolol Propranolol Group III Drugs Bretylium (Bretylol) Amiodarone (Cordarone) a. bluish discoloration of skin b. prevents the recurrence of V-fib Dofetilide (Corvert) Sotalol (Betapace) Group IV Drugs Diltiazem Verapamil Avoid grapefruit juice Nifedipine Amlodipine Cardiac Modalities 1. Automated External Defibrillator (AED) 2.Automated Implantable Cardioverter Defibrillator (AICD) Turn on the power. Attach the AED pads to the victim’s chest. Push the analyze button. Announce, “Stand clear.” Wait for the shock to be delivered Deliver up to three shocks if indicated. The device is programmed to detect cardiac arrhythmia and correct it by delivering a jolt of electricity. Notify the physician: If the patient was given a shock - sudden cardiac arrest 3. Holter Monitor “Ambulatory ECG” done where? – painless and non-invasive What to expect while wearing the device: Other electronic devices can affect monitoring Never allow the device to become wet (Swimming, Complete shower, Increased sweating) CORONARY ARTERY DISEASE (CAD) Causes: ATHEROSCLEROSIS Increase LDL fatty plaques thrombus clots platelet plugs Diagnostic Test: 1. Stress Test Management: Thrombolytics – to dissolve the clot Antihyperlipidemic – to lower down cholesterol Anticoagulant Antiplatelet to prevent clot formation -Determines the amount of stress that the heart can manage before developing an abnormal rhythm or ischemia Pre-test: NPO 4-6 hours Avoid caffeine 12 hours prior Do not take vasodilators During: If there’s ECG changes – STOP the test! 2. Cardiac Catheterization  Is an invasive diagnostic procedure in which radiopaque arterial and venous catheters are introduced into selected blood vessels of the right and left sides of the heart. PROCEDURE: Site: Femoral artery Local anesthesia Incision is made Guidewire Catheter is inserted Iodine is used TREATMENT: PTCA (Percutaneous Transluminal Coronary Angioplasty) CABG (Coronary Artery Bypass Graft) PROCEDURE: POST: - Sandbag (5lbs) to provide pressure – to prevent bleeding -Keep the leg straight 4-6 hours to promote healing -Complete Bed rest (CBR) for 12hours What do we watch out for? PRE- General anesthesia POST: Mediastinal Tube – How much drain is considered normal? WOF: Deep vein thrombosis (DVT) – blood clots formed in the lower legs and thigh PRIORITY: ANGINA MYOCARDIAL INFARCTION (MI) OCCLUSION TIME PAIN Name the types of Angina: * – due to (stenosis) vasoconstriction Pain during activity Mgt: * – due to thrombus Pain at rest Mgt: * – due to vasospasms Pain at rest Mgt: MANAGEMENT: Nitroglycerin Sublingual (SL) Sips of water Sensitive to light Six months allowance before expiration Transdermal patch – non hairy area Nurse must wear: trim/clip wet 12 – 16 hours on 8 hours off – to prevent drug tolerance Rotate sites Discard: OCCLUSION TIME PAIN Name the 3 Stages of MI: 1. – decreased oxygen to the heart causes chest pain WOF: Dizziness, signifies decreased oxygen to the brain 2. – 3. – Permanent damage to the heart (necrosis) Diagnostic Tests: Troponin I - 3 hours after the attack CK-MB - 18 hours after the attack Myoglobin - 2 hours after cell death Others: Erythrocyte Sedimentation rate (ESR) F: 0-20mm/hr M: 0-15 mm/hr C-reactive protein 1.0mg/L White Blood Cell count (WBC) 4,500 – 11,000/ mm3 MANAGEMENT: M O N N A INFECTIOUS CARDIAC DISORDERS 1. INFLAMMATORY HEART DISEASE ENDOCARDITIS Endocardium - Inner layer of the heart MYOCARDITIS Myocardium - Muscle layer of the heart PERICARDITIS Pericardium- Outermost layer of the heart Heart valves become incompetent vegetation murmurs infective emboli skin: petechiae purpura nodules Decrease in muscle contraction Chest pain Cardiac with fatigue Dysrhythmia Inflammation of pericardium Pain upon inhalation and when lying supine Pleural friction rub WOF: REPORT: MANAGEMENT 1.Penicillin 2. Corticosteroid can be given to all 3 inflammatory heart diseases 3.Vancomycin 2. CARDIAC TAMPONADE Increase in Pericardial fluid Pericardial Effusion Compression of the heart S/SX: What are the 3 manifestations in Cardiac Tamponade? Management: PERICARDIOCENTESIS -Aspiration of fluid in the pericardial space Pre: Position 45-60 degrees angle Post: Monitor VS every 15mins for the 1st hour Assess heart and lung sound Record the amount of fluid collected ECG – to assess cardiac rhythm Semi-fowler’s position COMPLICATIONS FROM HEART DISEASE CONGESTIVE HEART FAILURE (CHF) LEFT SIDED HEART FAILURE Backflow of blood where? RIGHT SIDED HEART FAILURE Backflow of blood where? DIFFICULTY OF BREATHING ORTHOPNEA PAROXYSMAL NOCTURNAL DYSPNEA BIBASILAR CRACKLES NON PRODUCTIVE COUGH FROTHY SPUTUM DECREASED CARDIAC OUTPUT OLIGURIA DISTENDED NECK VEINS JUGULAR NECK VEIN DISTENTION ABDOMINAL DISTENTION (ASCITES) INCREASED ICP HEPATOMEGALY SPLENOMEGALY EDEMA WEIGHT GAIN Measurement of Heart Function CVP (Central Venous Pressure) PCWP (Pulmonary Capillary Wedge Pressure) MEASURES THE SIDE OF THE HEART NORMAL CVP: MEASURES THE SIDE OF THE HEART NORMAL PCWP: ABDOMINAL AORTIC ANEURYSM (AAA) CAUSE: Obstruction due to thrombus,clots, plaques Worsened by Hypertension Pulsating Abdominal mass How do you know the patient is experiencing an impending rupture? Surgery: Endovascular stent graft / resection Management: Statins – to lower down cholesterol Thrombolytics – to dissolve the clot Anticoagulant – to prevent clot formation Antihypertensives – to decrease blood pressure -placed inside the aorta to keep the aneurysm from bursting What is the important consideration in patients with AAA? ***COR PULMONALE*** -Failure of the right side of the heart causing lung congestion due to pulmonary hypertension. s/sx: Right sided heart failure signs and symptoms Pulmonary symptoms POINTS TO REMEMBER: Arterial Disorders vs. Venous Disorders Arterial Venous “TOO LOW CIRCULATION” Pallor Absent Pulses Cool to touch INTERMITTENT claudication Management: Dangle/ Dependent position “TOO MUCH CIRCULATION” Swelling Throbbing pain Bounding Pulse Heavy and aching Warm to touch Brownish discoloration Management: Elevate the legs Arterial Disorders PAD Peripheral Arterial Disease BUERGER’S DISEASE “Thromboangiitis Obliterans” RAYNAUD’S DISEASE Claudication – cramping pain in the leg due to little blood flow MANAGEMENT: 1. Complete bed rest for 5-7 days DOC: Statins TPA’s (thombolytics) – dissolves the clot Anticoagulant – prevents clot formation NSAIDs – to decreasepain RISK FACTORS: MALES AUTOIMMUNE SMOKING S/SX: Rubor - red Pallor - pale Gangrene - necrosis MANAGEMENT: Thrombolytics Corticosteroids BKA (Below the Knee Amputation) AFFECTED AREA: lower legs and feet RISK FACTORS: FEMALE COLD CLIMATE STRESS VASOCONSTRICTION S/SX: White - pale Blue - cyanosis Red MANAGEMENT: CALCIUM CHANNEL BLOCKERS (Vasodilating effect) AFFECTED AREA: hands and fingers Venous Disorders SVC SYNDROME (Superior Vena Cava Syndrome) DVT (Deep Vein Thrombosis) VARICOSE VEINS -DIRECT OBSTRUCTION OF THE SVC DUE TO MALIGNANCIES S/SX: FACIAL EDEMA PERIORBITAL EDEMA JUGULAR VEIN DISTENTION FACIAL FLUSHING DSYPNEA COUGH CHEST PAIN MANAGEMENT: Corticosteroids – to decrease inflammation Diuretics –removal of excessive fluid to prevent cerebral edema -PROLONGED IMMOBILITY Risk Factors: Pregnancy Obesity Oral contraceptives Post Surgery Smoking Sitting for long periods of time (driving or flying –travel) S/SX: SWELLING / EDEMA BOUNDING PULSE WARM TO TOUCH THROBBING PAIN TENDERNESS -PROLONGED STANDING S/SX: SUPERFICIAL VEINS Clinical hallmark: **VEIN DILATION** MANAGEMENT: SCLEROTHERAPY Injection of a salt solution to shrink the veins LASER COAGULATION High focused beam of light is used CHEMOTHERAPY – for the treatment of tumor (+) HOMAN’S SIGN Pain upon dorsiflexion of the foot Increase calf circumference MANAGEMENT: Thrombolytics Anti-Embolic stockings -should be placed before getting out of bed PREVENTION: Early ambulation VEIN LIGATION Vein stripping – removal of a damaged vein CONCEPT: RESPIRATORY SYSTEM ARTERIAL BLOOD GAS (ABG) STEPS: 1. pH: This measures hydrogen ions. Provide the normal value. 2. pCO2= Partial Pressure of Carbon Dioxide: A high pCO2 may indicate ACIDOSIS. A low pCO2 may indicate alkalosis. Provide the normal value. 3. HCO3- = Bicarbonate: High values may indicate ALKALOSIS since bicarbonate is a base. Low values may indicate acidosis. Provide the normal value. COMPENSATION: Fully compensated pH: normal; both pCO2 and HCO3 abnormal Partially compensated pH, pCO2 and HCO3 are abnormal Uncompensated pH: abnormal, either pCO2 or HCO3 is abnormal ABG PRACTICE TEST 1. pH= PCO2= 7.50 45 HCO3= 28 2. pH= PCO2= 7.20 50 HCO3= 22 3. pH= PCO2= 7.30 48 HCO3= 29 MECHANICAL VENTILATOR To mechanically assist or replace spontaneous breathing LOW PRESSURE ALARM HIGH PRESSURE ALARM Total or partial disconnect. Loss of airway (total or partial extubation). Air leak. Secretions, coughing or gagging. Patient fighting ventilator (vent asynchrony). Condensate (water) in tubing. Obstructed, kinked ET tube. Increased resistance (bronchospasm). Decreased compliance (pulmonary edema, pneumothorax CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) CHRONIC BRONCHITIS Smoking Pollutants Occupational hazard Chronic exposure Mucous membrane edema Bronchospasms Increased mucus production Fibrosis – formation of connective tissues Hypoxia Cyanosis EMPHYSEMA Smoking Antitrypsin deficiency Destruction of the elastic recoil Air trapping Overinflation of the alveoli No more room for fresh air Management: Diet: 1. flow oxygen 2. breathing 3. question ASTHMA TUBERCULOSIS (TB) RISK FACTORS: Signs and Symptoms: Low Socio-economic status Low grade fever, cough, night sweats Immunocompromised patients fatigue and weight loss Health care workers DIAGNOSTIC TESTS: 1.Mantoux Test (skin test, tuberculin test, (PPD) purified protein derivative ) - Determine the amount of exposure 2.Chest x-ray – Determine the extent of lesions Consolidation and infiltrates – suggests scars and nodules in the lungs 3.Acid Fast Bacilli Smear (AFB smear, sputum test/culture) Increase fluids the night before the test – to loosen secretions Steam inhalation (nebulizer – use sterile water) Rinse the mouth ONLY – Do not brush the teeth No gum or candy on the day of the test May alter the results!!! No commercial mouthwash Procedure: Breathe in and out twice, breathe in then expectorate (give out sputum) Sputum sample: 15 ml ***done in 3 consecutive mornings PULMONARY EMBOLISM Risk Factors: 1. Prolonged immobilization 2. Surgery 3. Obesity 4. Pregnancy 5. Congestive Heart Failure 6. Long bone fracture Fat Embolism: Petechiae – where? Snow storm appearance on x-ray CAUSES: Fat , Air, Amniotic fluid Septic ,Thrombus SIGNS AND SYMPTOMS: Dyspnea Diaphoresis Tachypnea Tachycardia Cough Chest pain Pink frothy sputum WHAT TO DO: 1.Notify the physician 2.Administer oxygen 3.Administer IV 4.Prepare for intubation and mechanical ventilation 5.Monitor vital signs and respiratory condition 6.Document Diffuse pulmonary infiltrates (flake-like pulmonary shadows) PNEUMOTHORAX – Air in the pleural space Open – penetrating sharp trauma ( “sucking sound”) Example: gun shot wound, stab wound Tension – blunt trauma Example: Inflicted pressure on the chest wall Flail chest – ribs are detached to the chest wall which can lead to paradoxical breathing (unilateral chest expansion) Spontaneous – rupture of small bleb (air sacs) in the lungs Example: Smoking, lung disease and COPD Assessment Findings: Unilateral chest expansion (Paradoxical breathing) Diminished/Absent breath sounds Complication: Tracheal deviation – trachea shifts toward the opposite side due to intrathoracic pressure within the chest cavity Diagnostic test: Chest X-ray - Pitch black (affected area is darker than the rest of the lung fields ) Management: Chest Tube Thoracostomy (CTT)