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CARDIOLOGIC NURSINGECG CHANGES:
LAYERS OF THE HEART 1. Hypokalemia: low K+; U wave (hypUkalemia); depressed st segment;
1. Endocardium: Innermost; responsible of the structure of the heart flat T wave
2. Myocardium: Middle layer; muscle; responsible for heart contraction; 2. Hyperkalemia: high K+; prolonged QRS; elevated ST segment; Peak T
cardiac output; one of the strongest muscle in the body (always pumping) wave
3. Pericardium: Outermost; protects the heart 3. Myocardial Infraction (MI): Pathologic Q wave; elevated St
a. Visceral pericardium: inner segment; Inverted T wave
Pericardial space: pericardial fluid (prevents friction rub) w/o this it can lead
to tissue damage leading to inflammation; >50ml fluid = Cardiac Tamponade 3. HOLTER MONITORING (ambulatory ECG)
(cardiac emergency) - 24 hrs (1hour break: bathing)
b. Parietal pericardium: outer - A.k.a. Telemetry Unit
Chambers of the Heart (4) - nurse, client, So = log record activities and
1. Right atrium any unusual sensations
2. Right ventricle - instruct client to resume normal activities
3. Left Atrium
4. Left ventricle 4. 2D ECHO
Flow of blood in the heart is 1 way — assess cardiac structure and mobility
- painless; 30-60 mins; no special preparation is needed
Regurgitation is 2 way (Valvular problems)
5. TREADMILL TESTING/ STRESS TEST
CONDUCTION SYSTEM OF THE HEART
(HEART AND BRAIN) = ELECTRICAL Purpose:
A. Identify ischemic heart disease
1. SINOATRIAL NODE (SA NODE): primary pacemaker; (60-100bpm)
B. Evaluate chest pain
2. Atrioventricular Node (AV NODE): slowest conductor; (40-60bpm)
C. Evaluate effectiveness of the therapy
3. Bundle of His: distributes electricity to ventricles; (30-40bpm)
D. Fitness program during cardiac rehabilitation
4. Purkinje Fibers: Fastest conductor; (20-40bpm)
Responsibilities:
S-top taking tea, alcohol and coffee a day before (alteration of result
PROPERTIES OF THE HEART (CHARACTERISTICS OF THE HEART)
T-ake comfortable clothing and shoes
1. Automaticity: repetitive and spontaneous
R-est adequately a night before
2. Excitability: Stimuli
E-xplain the need to report to SOB and CP (chest pain)
3. Conductivity: ability to transmit impulses
E-at light meal only 2hours before
4. Contractility: pumping action of the heart
S-top smoking can cause vasoconstriction may alter result
5. Refractoriness: inability to response to a new stimulus while still on
S-top NTG(nitroglycerin) 2 hours before
contraction. (Dysrthmia may happen w/o this)
HEART SOUNDS 6. CARDIAC CATHERIZATION (contrast agent in femoral artery)
1. S1: Lub- due to closure of the AV valves PURPOSE:
2. S2: dub- Due to closure of the Semilunar valves • to assess heart structures
3. S3: due to increase ventricular filling (S3=CHF) (common geria) • Assess pulmonary flow
4. S4: Due to forceful atrial contraction (Hy-per-ten-sion=S4) (athlete) • Can assess oxygen levels
RESPONSIBILITIES;
DIAGNOSTIC PROCEDURE
Pre-procedure; Post procedure:
1. Cardiac Enzymes:
• C-onsent • C-heck area distal to insertion site
- Myoglobin: tissue necrosis = immediately after MI attack (first hour)
• A-nesthesia • A-ssess VS
- CK MB: cardiac specific, accuracy and myocardial damage: definitive
• R-ecord baseline VS • T-amang position (bedrest 6-8hrs)
Cardiac enzyme
• D-amdamin (flushy warm • H-ipflexion not >30 degrees
2. ECG(electrocardiography)
feeling) • E-nsure pressure application (pvnt blee
- P wave: Atrial contraction (last for 0.04-0.11 secs)
• I-odine Allergy • T-ake your fluids (inc OFI to excrete
- PR interval: time impulse travel from SA to AV node(0.12-0.20 secs)
(seafoods,shellfish) dye)
- QRS complex (triangle): ventricular contraction (0.05-0.10 secs)
• A-void eating; NPO4-6hrs • E-CG changes monitoring
- ST segment; slow repolarization of ventricles
• C-lean insertion site • R-eport allergic reactions to dye
- T wave; Ventricular relaxation CHEST LEADS
V1- RED
PHARMACOLOGIC MANAGEMENT
Right Left V2- YELLOW
1. DIGITALIS (DIGOXIN):
(Marcos) (Aquino) V3- GREEN
• (+) Inotropic: stregth of contraction
V4- BROWN
• (-)Chronotropic: rate of contraction
Red Arm Yellow arm V5- BLACK
• (-)dromotropic: transmission of impuleses
V6- VIOLET
-maximize CO, but providing heart to rest
*toxicity: N-ausea, A-norexia, V-isual Disturbances(vomit), D-iarrhea,
Black foot Green Foot A-bdominal cramps (1or 2 stop giving this and give DIGIBIND instead
ANTIDOTE; Digibind: digoxin immune Fab
, CARDIOVASCULAR DISORDERS
NURSING RESPONSIBILITIES:
• D-IGIBIND at bedside Irreversible
• I-nstruct to measure pulse daily
• G-ive foods high in potassium
• O-bserve signs of hypokalemia
• X- do not give if HR is <60bpm
• I-nstruct to WOF s/sx of toxicity (NAVDA)
• N-ote that elderly are more sensitive bec or deterioration of 3X MAX, q5 mins
organs (kidneys) slow metabolism and excretion
2. CALCIUM CHANNEL BLOCKERS (DIPINE)
NURSING RESPONSIBILITIES:
• C-alcium level monitoring (milk-gatas = 4.5-5.5 mEq/dl)
• A-ssess pulse and BP
• A-ntidote is GLUCAGON NO ECG CHANGES
• L-iver enzyme levels (SGOT/SGPT)
• C-lient should not crushed or chew tablets (enteric coated) ANGINA
• I-nstruct to take the drug before or 2 hours after before meals
NURSING RESPONSIBILITIES:
• U-sual kidney function test BUN and creatinine
• A-ssessed pain
• M-D notify if with dizziness and fainting (Hypotension)
• N-itroglycerin SL 3x mac q5 mins
3. BETA BLOCKERS (OLOL) Beta 1: targets the heart (1 b • G-ive O2 at 3Lpm
NURSING RESPONSIBILITIES: Beta 2: targets lungs (2b • I-nstruct to stop activity and rest if pain occurs
• N-otify physician if pain persist
B-P and HR Monitoring
• A-spirin
B-awal sa asthma
L-ook for respiratory distress MYOCARDIAL INFACTION
O-rthostatic Hypotension due to positional changes (gradual changes)
NURSING RESPONSIBILITIES:
C-HF Detection causing insufficient pumping leading congestion
K-eep taking prevent rebound hypotension • I-ncrease fiber, decrease sodium, fat, cholesterol in the diet
E-liminate OTC cold preparation (with alcohol content= depressant) • N-itroglycerin
R-eport dizziness and lightheadedness (toxicity) • F-owler’s position HOB- to maximize lung expansion enhances
oxygenation
4. ANTIPLATELET AGGREGATE (ASA/ASPIRIN) (PREVENTS COAGULATION) • A-dminister Morphine(pain), Oxygen, Nitroglycerin, Aspirin (MONA)
A-ssessed s/sx of bleeding • R-ecord BP after administration of meds
S-training of stool is prohibited • C-ardiac Monitoring
A-spirin toxicity (Tinnitus=ringing of the ear) • T-hrombolytic therapy
4 A’s of aspirin • I-monitor ECG changes
• Antiplatelet effect • Anti inflammatory effect • O-2 at 2-4Lpm
• Antipyretic effect. • Analgesic effect • N-ote for signs of bleeding if receiving thrombolytic therapy
5. ANTICOAGULANTS heparin/warfarin (PVNT FURTHER COAGULATION)
HEPARIN: short term
• H-ave protamine sulfate at hand CARDIOMYOPATHIES (3 TYPES)
• E-nd after 2wks of therapy 1. DILATED (enlarged heart)
• P-TT and aPTT check Causes: idiopathic, alcohol, cocaine use
• A-ssessed for bleeding S/sx: weakness, fatigue, activity intolerance, dysrhythmias
• R-emind not to aspirate and massage (IV/SQ) Management: Heart Transplant
• I-njection via SQ/IV
• N-ote for hematoma on site of injection sign of bleeding 2. HYPETROPHIC (hypertrophic ventricles/thickening)
WARFARIN: GIVEN ORALLY • can’t distribute blood
W-OF s/sx of bleeding causes: idiopathic, hyperparathyroidism, hypercalcemia, HPN
A-ntidote is Vitamin K S/sx: sudden death; initial manifestation
A-ssess Prothrombin time regularly Management: do not give diuretics, give dopamine, digitalis (maximize CO),
R-eminder: ASA+Coumadin=severe bleeding DOC: ethanol injection
R-eminder: Avoid green leafy vegetables because are rich in vit K.
3. RESTRICTIVE Cardiomyopathy: restricted contraction
6. THROMBOLYTICS (DESTROY BLOOD CLOT) (KINASE) Causes: infection from the lungs
I-njection is avoided S/sx: weakness, exertional dyspnea
B-LEEDING MONITORING
N-ice to use electric razor Management: Use diuretics, vasodilators, digitalis
L-ook occult blood
G-et ready for aminocaproic
E-mploy pressure on punctured sites
acid/amicar (antidote)
E-xplore neuro changes
D-etermine hypertension and tachycardia
, PERICARDITIS DEFIBRILLATION (unconscious patient)
Types: • asynchronous delivery of shock
1. Acute: resulting from inflammation of visceral and parietal pericardium 1st shock : 200J
2. Chronic: reoccurrence; repeated pericarditis 2nd shock: 300-360J
COMMON MANIFESTATION: CHEST PAIN aggravated by movement; Chest 3rd shock: 360J
pain is relieved by sitting/upright position/leaning forward (orthopneic Max is 3bec it can cause bursting of the heart
position tripod)
Paddle:
MANAGEMENT:
MANAGEMENT:
• first: located in sternum
A-analgesics, antibiotics, NSAIDS
• Second: located in apex
C-heck result of blood culture
U-pright position / leaning forward/ fowler’s position MANAGEMENT:
T-ell physician if cardiac tamponade occurs (common complication) • no oxygen (it is flammable); no touch
E-wasan administration of Aspirin and anticoagulants (blood thinners cause
cardiac tamponade CARDIOVERSION Conscious patient
HEART FAILURE • synchronous delivery; shock is delivered in QRS
-Insufficient cardiac output • Smaller amount: 50J
2 types: Pre-procedure
1. Right sided heart failure (systemic in nature) • consent
2. Left sided heart failure (lungs=pulmonary) • Serum k+
*concept of backflow • Digitalis (therapeutic level) 0.5-1.0
• Pre-medicate the client with anti dysrhythmic drugs
RSHF:systemic LSHF:pulmonary
• peripheral edema, dependent, • dyspnea on exertion Post procedure
pitting • Orthopnea (diff. Breathing) • checked for NSR (normal sinus rhythm)
• Weight gain • Fluid retention; crackles/rales • Check pulse
• Distended neck veins • Cough • Maintain airway patency
(JVD:jugular vein distention • Tachycardia: compensatory
• Hepatomegaly(enlarged liver) mechanism (early stages)
(portal HPN causing ascites,
esophageal varices, hemorrhoids)
• body weakness
• Anorexia and nausea
HPN and tachycardia for both
DIAGNOSTICS:
• CHEST X-RAY: cardiomegaly
• 2D ECHO: hypokinetic heart (slow heart movements late manifestation)
• PULSE OXIMETRY: decrease 02 saturation (95-100%) if lower tissue
perfusion
• PCWP (pulmonary capillary wedge pressure) LSHF (4-12mmHg)
• CVP(central venous pressure): RSHF (8-12mmHg)
MANAGEMENT:
MANAGEMENT
F-owler’s Position (maximize lung expansion= enhance oxygenation)
A-dminister high O2 (Venturi Mask low flow but high concentration which
delivers accurate and precise concentration)
I-notropic drugs (increases strengthens contraction of heart) increase
cardiac output
L-anoxin/Digoxin (NAVDA) Antidote: digibind
U-rine output and intake monitoring
R-ecord daily weight (same time, clothes, weighing scale, patient)
E-dminister Diuretics (to promote excretion and lessen edema and pressure)
CARDIAC TAMPONADE
—Cardiac emergency
-Rapid accumulation of fluid in the pericardial sac
• BECK’S TRIAD
- Jugular vein distention
- Muffled heart sounds (fluids)
- Hypotension (no forceful contraction)
MANAGEMENT: • Fowler’s position
• Pericardiocentesis (removal of fluid)
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