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Cardiovascular 6

  1. Cardiac tamponade
  2. Definition/etiology
    1. fluid quickly fills pericardial sac and limits cardiac output; cardiac tamponade is a medical emergency 
    2. etiology
      1. acute pericarditis
      2. post-op after cardiac surgery
      3. pericardial effusions
      4. chest trauma
      5. myocardial rupture
      6. aortic dissection
      7. anticoagulant therapy
  3. Findings: classic triad of findings
    1. hypotension with
    2. muffled heart sounds with
    3. high jugular venous pressure (increased CVP)
  4. Diagnosis (above)
  5. Management
    1. pericardiocentesis: needle aspiration of pericardial sac
  6. Nursing interventions
    1. bed rest with elevated head of bed
    2. prepare client for pericardiocentesis
    3. provide emotional support

. Disorders of the Circulatory System:

    1. Hypertension (illustration)
      1. Definitions
        1. hypertension - systolic blood pressure of 140 mm Hg or greater, diastolic blood pressure of 90 mm Hg or greater, or taking antihypertensive medication
        2. chronic hypertension of pregnancy - high blood pressure already present before week 20 of gestation
        3. accelerated hypertension - a hypertensive crisis: blood pressure rises very rapidly, threatening the brain
      1. Etiology and epidemiology 
        1. essential hypertension: cause unknown.
        2. possible factors include:
          1. family history- immediate family: mother, father, siser, brother
          2. race- African American, Hispanic, Native American, more susceptible
          3. stress
          4. obesity- 20% more than ideal weight
          5. a diet high in sodium or saturated fat
          6. use of tobacco
          7. use of hormonal contraceptives
          8. sedentary life-style
          9. aging
        3. besides hypertension, most individuals have other risk factors for cardiovascular disease (CVD).
        4. secondary hypertension may result from
          1. renovascular disease
          2. renal parenchymal disease
          3. cushing's syndrome
          4. diabetes mellitus
          5. dysfunction of the thyroid, pituitary, or parathyroid
          6. coarctationof the aorta
          7. pregnancy
          8. neurologic disorders
      1. Findings
        1. may be asymptomatic
        2. findings reflect the effect of hypertension on organ systems
        3. occipital headache, blurred vision, dizziness
        4. dizziness, palpitations, weakness, fatigue, and impotence
        5. nosebleeds
        6. bloody urine
        7. chest pain and dyspnea, if heart is involved
      2. Diagnosis
        1. 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
        2. classification of adult hypertension

      1. hypertension is classified according to its cause:
          1. primary or essential hypertension (about 90% of clients)
          2. secondary hypertension (results from another disease; about 5% to 10% of clients)
          3. accelerated hypertension - a hypertensive crisis
      1. Management
        1. pharmacological
          1. initial therapy - for uncomplicated hypertension, it is recommended to start with a diureticor Beta-adrenergic blocking agent
          2. oxygen PRN in acute crisis
          3. angiotensin-converting enzyme(ACE) inhibitors are used to treat left-sided heart failureand preferred if client is diabetic
          4. antilipemics
        2. goals of treatment
          1. BP <130/85 mm Hg
          2. control dyslipidemia, obesity, inactivity
          3. control diabetes mellitus, if indicated
      2. Nursing interventions: reinforce client and family teaching regarding:
        1. client to use self-monitoring blood pressure cuff
        2. client to record readings at least twice weekly in a journal or calendar for review by care provider during visits
        3. client to set up routine for taking antihypertensive medications
        4. the need to warn against high-sodium antacids, and cold or sinus remedies with vasoconstrictorssuch as antihistamines
        5. diet low in sodium, cholesteroland saturated fat
        6. when client is to report extremely high blood pressure readings
        7. lifestyle modifications
          1. optimize body weight
          2. drink alcohol based on current guidelines
          3. moderate dietary sodium (two gm sodium diet)
          4. exercise: regular moderately intense aerobic activity
          5. avoid tobacco products
          6. manage stress triggers and responses to triggers
    1. Coronary artery disease (illustration)
      1. 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.
      2. Epidemiology and etiology
        1. CAD is epidemic in the western world.
        2. more than 30% of men age 60 or older show signs of CAD on autopsy.
        3. most common cause: Atherosclerosis
        4. risk factors:
          1. over 40 white male
          2. family history of CAD
          3. high blood pressure
          4. high cholesterol 
          5. 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.
          6. obesity (waist predominance); [added weight increases the risk of diabetes, hypertensionand high cholesterol]
          7. sedentary life style
      3. Findings: angina 
      1. Management
        1. pharmacology
          1. nitrates such as nitroglycerin, isosorbide dinitrate (Isordil), or beta-adrenergic neuron-blocking agents
          2. oxygen - to prevent hypoxia
          3. diureticsand beta-adrenergic blocking agents
          4. aspirin - decreases platelet aggregation
          5. antilipemics- to decrease circulating lipids
        2. diet: reduce calories, salts, fats, cholesterol
        3. cardiac catheterization
          1. 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.
          2. check for distal pulses.
          3. to counter the diuretic effect of the dye, increase IV fluids and make sure client drinks plenty of fluids.
          4. assess potassium level- observe for dysrhythmias
          5. observe findings of hypotension, bradycardia, diaphoresis, dizziness; give atropine and lay the client flat.
        4. rotational ablation
          1. after rotational ablation, monitor the client for chest pain, hypotension, coronary artery spasm and bleeding from the catheter site.
          2. provide heparin and antibiotic therapy for 24 to 48 hours or as ordered.
        5. laser coronary angioplasty
        6. surgical treatment - coronary artery bypass graft (CABG)