Transcript Post Cardiac Surgery

Cardiovascular
Challenges
NURS 2016
Chapters: 27-32
CV Challenges
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Hypertension
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Coronary Vascular disorders
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Congestive Heart Failure
Diet and Blood Cholesterol
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Factors include: cholesterol, total and type
of fat, dietary fibre and energy
¾ of cholesterol is manufactured in liver
2/3 population: liver manufactures
fluctuate with dietary intake
1/3 population: liver production does not
accommodate dietary intake
Factors affecting Heart Disease
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Cholesteral
LDL
HDL
Triglycerides
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Goal : Low LDL values, High HDL values
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 Triglycerides
<200mg/dL
 Low cholesteral
Hypertension
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BP > 140/90mmHg over a sustained
period
Approximately 20% adult population in
Canada
Primary hypertension
Secondary hypertension
Hypertension
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Sign
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Risk
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Disease
Complications of Hypertension
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Left ventricular hypertrophy
Myocardial infarction
Heart failure
Transient Ischemic Attacks or Cerebral
Vascular Accident
Renal insufficiency
Retinal hemorrhage
Nursing Assessment
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Angina
Shortness of breath
Alterations in speech, vision, or balance
Headaches
Dizziness
Nocturia
Monitor BP
Monitor for symptoms-target organ damage
Pt. knowledge deficit
Goal
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Decrease BP to normal range without
causing adverse affects or undo cost
Nursing Intervention/Action
Teaching/Learning
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Lifestyle
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Medication regime
Lifestyle
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Increase aerobic activity
Obtain and maintain optimal body weight
Discontinue smoking
Decrease intake of saturated fats &
cholesterol
Limit intake of alcohol
Lifestyle
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Electrolytes
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Na+:
K+:
Ca+:
Mg+:
RNI
RNI
RNI
RNI
500-2400mg (1/4 tsp salt)
2000mg
800mg
200mg
Medication Regime
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Monotherapy is best
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Minimal/simple
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Approximately 50% of individuals discontinue
medication within one year
Encourage regular monitoring (self or other)
Coronary Vascular Disorders
Risk Factors
Non-modifiable
 Family hx of CAD
 Increasing age
 Gender
 Race
Modifiable
 High serum
cholesterol
 Cigarette smoking
 Hypertension
 DM
 Low estrogen
 Inactivity & obesity
 Stress
Angina
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Episodes of pain or pressure in the
anterior chest
Insufficient coronary blood resulting in
inadequate supply of O2
Can be induced by
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exertion, exposure to cold, eating a heavy
meal, stress, emotional situation (inc.
myocardial work)
Angina
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Pain:
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indigestion (choking, heavy sensation)
severe apprehension (impending death)
retrosternal (deep in chest)
poorly localized (neck, arm)
tightness (strangling)
SOB
vomiting
Types of Angina
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Stable
Unstable
Intractable or Refractory
Variant
Silent
Angina
Goal:  demand
Treatment Approaches
 supply
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Pharmacological
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Surgical
Pharmacological
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Nitroglycerin
Beta-adrenergic blocking agents
Calcium channel blocking agents
Antiplatelet and anticoagulant medications
Oxygen (2-4 L/m via nasal cannula)
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controversial
Nursing Dx
Angina
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Altered myocardial tissue perfusion
secondary to CAD, as evidenced by chest
pain.
Anxiety related to fear of death.
Learning need related to underlying
disease.
Teaching/learning opportunity related to
therapeutic regime.
Goals
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Immediate and appropriate txmt &
avoidance of complications
Decreased anxiety
Increase awareness of disease process
Understanding of prescribed care,
adherence to self-care program
Nursing Intervention
Pain
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Immediate action required
Patient to D/C all activity
Sit or recline in semi-fowler’s position
Assess pain and vital sign & O saturation
Administer nitroglycerin (if ordered),
repeat x 3 if needed
Administer oxygen
ECG
2
Surgical Intervention
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Percutaneous Transluminal Coronary
Angioplasty (PTCA)
Coronary Artery Stent
Coronary Artery Bypass Graft
Nursing Care
Post Cardiac Surgery
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Neurologic status
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Cardiac status
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Respiratory status
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Peripheral vascular
status
Fluid & electrolyte
status
Pain
Nursing Interventions
Post Cardiac Surgery
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Restoring Cardiac output
Promoting Adequate Gas Exchange
Maintaining Fld & Elect. Balance
Reducing symptoms of Sensory Overload
Relieving Pain
Maintaining Adequate Tissue Perfusion
Maintaining Adequate Renal Perfusion
Maintaining Adequate Body Temperature
Myocardial Infarction
Areas of myocardial
cells are permanently
destroyed
 Chest pain not
relieved with
antianginals or rest
 Dx based on hx, ECG
and lab results
Diagnostic Lab Tests
MI
Creatine Kinase (CKMB)
 Increased within 1hr
and peaks at 24h
Lactic Dehydrogenase
 Peaks at 2-3 days
Myoglobin
 Negative results may
indicate no MI
Troponin
 An elevated serum
level indicates an MI
Thrombolytic Therapy
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Used to dissolve or lyse the thrombus in a
coronary artery
‘Door to needle’ time: quicker the better
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3 hours
Streptokinase
TPa
Retavase
Health Promotion
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Nutrition
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Activity
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Symptom recognition and management
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NCP for MI
Nursing Care Plan
Uncomplicated for MI
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Ineffective cardiopulmonary perfusion
Potential of effective air exchange
Risk for inadequate tissue perfussion
Anxiety
Knowledge deficit
Congestive Heart Failure
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Occurs when the contractility of the heart
is reduced & the ventricle is unable to
pump as much blood out during systole as
comes in during diastole
Inability of the heart to pump sufficient
blood to meet the needs of the tissues for
oxygen and nutrients.
Sidedness
Left Sided
 Most common
 Blood backs up into
pulmonary veins
 Forces fluid shift
leading to pulmonary
congestion and
edema
Right Sided
 Blood backs up into
venous circulation
 Peripheral edema,
hepato/splenomegaly,
jugular distention
Planning & Goals
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Manage fluid overload
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Decrease peripheral edema
Decrease shortness of breath
Increase activity tolerance
Knowledge of treatment regime and self-care
Decreasing incidence of anxiety
Able to verbalize ability to make decisions/
influence outcomes
Promoting Activity Tolerance
20-30 minute physical activity daily
 Warm up activity (3 minutes)
 Avoid temperature extremes
 Ensure ability to talk during activity
 Wait 2 hours pc prior to activity
 Stop activity if pain, SOB or dizzy
 Cool down activity (3 minutes)
Managing Fluid Overload: Low
Sodium Diet
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500-1500mg sodium per day
Most sodium is added in processing of
food
Review the hand out on Sodium content
For fun, calculate your daily sodium intake
Other Nsg Interventions
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Control anxiety
Teach self care
Auscultate lung fields
Monitor I & O
Wt pts
Semi-high fowlers
Skin integrity/pos chgs
Elastic stockings/leg exercises