RN/PN Nclex CONCEPT: CARDIOVASCULAR SYSTEM Latest Updated 2022
BLOOD FLOW
Imagine in your mind how the blood circulation
... [Show More] 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) [Show Less]