Complications from Heart DIsease

Medical emergency

Anything that decrease the ability of the left ventricle to pump: MI, HTN, valvular disease, rapid arrhythmias

This of it backwards: LV not pumping well, get stasis of blood from LV. Blood coming in from LA cannot get in. Back up in LA comes from the lungs. The pressure in the vessels of the lungs goes up. As pressure goes up the fluid builds up in capp and leaks into alveoli

1. Restless
2. Sudden SOB, PND, orthopnea
3. crackles
4. cyanosis
5. gurgling respirations
6. PINK FROTHY SPUTUM

Pink frothy sputum

Paraxcismal Nocturnal dyspnea: when lying down the pts legs are level of the heart. Increase of the preload on the heart which makes is hard to breathe!

1. Improve the pumping of the left ventricle
2. Improve respiratory exchange

1. O2
2. Positive Inotropics
3. Morphine
4. Diuretics
5. Other meds
6. Swan Ganz Catheter
7. Assess for shock

1. Peep
2. Pulse oximeter monitoring
3. ABGs

1. Digoxin
2. Dopamine
3. Primacore, Inocor

RR (get a baseline)

-It is a peripheral venous dilator

1. Thiazide: HCTZ
2. Loop: Lasix
3. K sparing: Aldactone

Have them sit up and put legs dependent

It keeps (+) pressure in alveoli and drops the amount of fluid to leak into alveoli

The heart cannot pump adequate amount of blood to meet metabolic demands

I: No limitations
II: Slight limitations
III: Limitations to ADL
IV: symptoms even at rest

CHF

Is the second highest reason for seeing the HCP

1. CAD
2. Systemic or pulmonary HTN
3. Valvular heart disease
4. Increased workload of the heart

-anything that knocks out the L vent

Decrease in amount of blood ejected from the left vent --> Drop in CO --> increase in SNS -->Release of renin --> Angiotensin II and aldosterone --> Vasoconstriction and Fluid retention --> more drop in amount of blood ejected from the heart

(kidneys hold on to fluid to increase preload which should be a compensatory mech but it becomes a specific cycle

1. DOE
2. Orthopnea
3. PND
4. Cough
5. Crackles
6. Restlessness and anxious
7. Tachy
8. Pale
9. Nocturia
10. Decrease Urine
11. Increase BUN and Na
12. Fatigue
13. ABGs
14. Weight gain
15. Swan Ganz

In the lungs

Left sided heart failure

1. Right vent cannot empty fully
2. blood in right atrium becomes backed up
3. venous blood return to the heart becomes backed up --> congestion of large vessels and body organs.

1. Edema
2. Weight gain
3. JVD
4. CVP, swan ganz
5. anorexia
6. nocturia
7. Fatigue
8. Hepatomegaly, splenomegaly
9. ascites

The blood gets backed up into the portal system (venous engorgement) and then the person loses their appetite

1. FVE
2. Ineffective breathing pattern
3. Alteration in cardiac output: decreased
4. noncompliance with medications
5. knowledge deficit

1. decrease workload of the heart
2. increase myocardial contractility
3. eliminate excess fluid

1. Bedrest
2. O2
3. V/S
4. Breath sounds
5. Is & Os
6. Daily weights
7. skin care
8. diet
9. patient education

1. Ace Inhibitors
2, ARBs
3. Diuretics
4. Beta Blockers
5. Digitalis
6. Dobutamine/ Primacor
7. anticoags
8. antihypertensives
9. antianginal

Used in the Tx of CHF. Decrease the afteroad

-Dont have vasoconstricting actibvity. They decrease the work on the heart.

-Also decrease aldosterone which decreases the preload

-The prils

Dry cough due to bradykinin production

Angiotensin II Renin blockers

to block renin which will decrease preload and afterload

1. ACE: Capoten and Vasotec "prils"
2. ARB: Losartan

Furosemide: Lasix

K levels. Can also be dropped with Na and cause arrhythmias

Beta blockers

(-) chronotropic. Slow down heart rate. If it goes too slow then it will set off the SNS to increase the HR (BAD reaction)

Metoprolol and Carvedilol

Function: decreases the symptoms of heart failure to help pts icnrease their ADLs

- (+) inotroph= more efficient cardiac pumping

Caution: dig toxicity. Very small therapeutic level. causes blue green halos and bradycardia

The apical pulse! If < 60 hold the meds

Can decrease SxS of CHF to increase ADLs

Can also be used on an outpatient basis

An embolism that becomes lodged in the pulmonary artery, obstructing the blood supply to the lungs

size and location

Ventilation; perfusion

DVT

1.CHF
2. pelvic and leg trauma
3. post op (bed rest)
4. post partum

1. increase age
2. obesity
3. pregnancy4
4. BCPs
5. sedentary
6.smoking

Risk factors for PE

1. Venous Stasis
2. Hypercoaguability
3. Venous endothelial damage

1. increase platelet count
2. tumor
3. massive injury

IV catheters and Thrombophlebitis

1. Cyanosis
2. SOB
3. Tachypnea
4. Hemoptysis
5. Drop in O2 stat, Drop in PaO2
6. Chest pain

1. INEFFECTIVE GAS EXCHANGE
2. Ineffective breathing pattern
3. Drop in CO
4. Alteration in comfort: pain
5. Fear

It increases with each breath

Syncope, sudden shock, death

Prevention!

1. Passive/active ROM
2. OOB and ambulating ASAP
3. Adequate fluid intake: NO DEHYDRATE
4. Compression socks: TEDs
5. Do not cross legs
6. Assess Homan's Sign
7. If pt is at risk give: ASA, Plavix, Heparin, Lovenox

1. O2
2. Morphine
3. Anticoags, Thrombolytics: for big clots
4. ABGs
5. ECG
6. Surgical intervention: embolectomy
7. Greenfield filter

Fluid in the pericardial sac

-aka: Cardiac Tamponade

-infection: pericarditits
-CHF
-cardiac surgery
-trauma

Peripheral vascular disease

Disease of the blood vessels that supply the extremities. Usually in the legs

1. Arteriosclerosis /athero
2. Obstruction by thrombus or emboli
3. Sever vasoconstriction as in RAYNAUD's
4. Arterial inflammation usually associated with clots, as in Buergers

1. Doppler
2. Duplex Ultrasound
3. MRA
4. Arteriography or angiography

When pedal pulses are undetected

Duplex Ultrasound.

Non-invasive, small machine, no prep can be done at the bedside

Uses sound waves

Magnetic resonance angiography.

-uses contrast dye injected into arterial flow. SImilar to an MRI but uses different software

Test to check for PVD

-Check the systolic BP brachially, then check it on the leg and compare the ratio. should be close to1

the more it goes down, the worse the disease

1. Pain: intermittent claudication with exercise
2. Pulselessness
3. Polkilothermic: leg is cool
4. Pallor
5. Paresthesias
6. Paralysis

In the thigh. Usually pain is felt one joint level below the obstruction

Due to pulselessness and decrease flow

-Tend to be small, deep on the tip of the toes or even in between the toes.
-the medial side of the helix (grape toe)
-can develop into gangrene, may need amputation!

A pt with arterial PVD. when their leg is dependent it is red; when it is level with the body it is white, and when it is lifted up to the ceiling it turns blue

The extremity is cool due to arterial PVD

1. Risk for infection: may not realize they are injured
2. Risk for injury: Not aware because of lack of pain
3. Alterations in comfort: pain
4. Potential for impairment of skin integrity of lower extremities
5. Ineffective individual coping: amputation
6. Fear: amputation

CAD

1. Control the underlying disease and/or risk factors
2. Improve blood supply
3. Avoid vasoconstrictors
4. Prevent tissue damage

1. Position
2. Warmth
3. Exercise

Feet up in the air

1. Assess pulses
2. Good nutrition
3. obtain ideal body weight
4. inspect feet regularly
5. have podiatrist cut thick toenails
6. No tight shoes or socks

1. PTA
2. Meds: ASA, Ticlid, Heparin, Coumadin
3. Surgery: Endarterectomy, Vascular grafting, Amputation, Embolectomy

Percutaneous transluminal angioplasty: usually with a stent

Used in PVD:

separate the plaque from the artery wall to prevent its breakage and subsequent travel to smaller arteries

Femoral popliteal bypass graft. Diverts flow by bypassing the blocked artery

1. Phlebitis: inflammation of the vein
2. Venous Thrombosis: Clot
3. Thromboembolism: piece broken off and traveled
4. Deep vein thrombosis
5. Thrombophlebitis: clot and inflammation in the vein

Blood stasis --> initial damage --> hypercoaguability --> clot

1. Family Hx
2. Patients with own Hx
3. > 40yr
4. surgery of >30 mins duration
5. varicose veins
6. estrogen treatment: BCP or as a cancer treatment

1. Calf pain and tenderness
2. Edema
3. increase warmth to leg
4. Homan's sign

1. TED stocking or sequential compression
2. Early ambulation
3. RAISE the foot of the bed (not for arterial)
4. Passive and active ROM
5. Monitor IV sites and discontinue ASAP

1. Rest
2. Moist heat
3. anticoagulants

1. Instruct pt on elastic hose
2. walking
3. instruct for anticoag meds
4. SxS of bleeding
5. follow up blood tests
6. No smoking
7. Maintain normal weight
8. DC BCPs
9. ScS of phlebitis: call DR
10. No leg crossing, tight socks or garters

1. Elevate the legs
2. Pressure stockings
3. Encourage walking
4. Protect from trauma
5. Inspect daily & keep clean dry

Typically large, superficial and highly exudative.

Often occur on the medial or lateral malleous.

1. Transient Weakness
2. weakness, tingling
3. Speech may slur

Carotid sten or carotid endarterectomy

-Labile B/P (because of baroreceptors of carotid)
-Airway (internal bleeding can press on trachea)
-Make sure trachea is midline
-Neuro checks qh for the 1st 24 hours

A localized sac or dilation of the aorta wall

1. Thoracic
2. Abdominal aortic aneurysm "triple A"

Dacron graft that acts as the walls of the aorta

The pulse may actually be distinctly palpable over the abdomen.

HTN, arteriosclerosis and atherosclerosis