Jaw pain, headache, toothache, headache, shortness of breath, diaphoresis or breaking out in a cold sweat, palpitations, unusual fatigue, sometimes for days (especially women), Nausea or vomiting, Indigestion, Anxiety, feeling of impending doom, or denial that anything is wrong, Cool, pale, and moist skin, Lightheadedness, dizziness, or restlessness, Tachycardia or tachypnea, Crackles in lungs (if MI has caused pulmonary congestion), Pulmonary edema, Increased jugular vein distention (seen if MI has caused heart failure), Any sudden, o Dress the site with sterile gauze or sterile, transparent,, semipermeable dressing to cover the catheter site.
o Change gauze dressings every 2 days or transparent dressing at least every 7 days and whenever dressings become damp, loosened, or visibly soiled.
o Do not use topical antibiotic ointment or creams on insertion site.
o Asses the site regularly- visually when changing or by palpating intact dressing. Remove the dressing for a through assessment if the patient has tenderness at the site, fever without obvious source, or other signs of bloodstream infection.
o Keep all components of the pressure monitoring system sterile.
o Replace transducers, tubing, continuous device, and flush solution at 96 hour intervals.
o Do not infuse dextrose containing solutions through the monitoring system.
o Do not submerge the catheter or catheter site in water.
o Showering is permitted if the catheter and related tubing are place in an impermeable cover.
o Ask patients to report any new discomforts from the catheter site.
A transducer is attached, and pressure is measured in millimeters of mercury. the nurse monitors the patient for complications, which include local obstruction with distal ischemia, external hemorrhage, massive ecchymosis, dissection, air embolism, blood loss, pain, arteriospasm, and infection. o It is done by either exercise on a treadmill, pedaling a stationary exercise bicycle ergometer or with intravenous pharmacological stimulation using medicine such as adenosine or dobutamine, with the patient connected to an ECG. Stress test helps determine the following: presence of coronary artery disease, cause of chest pain, functional capacity of the heart after an MI or surgery, effectiveness of heart medications, occurrence of dysrhythmias, and goals for a fitness program. There are contraindications to a stress test, including: severe aortic stenosis, acute myocarditis or pericarditis, severe hypertension, suspected CAD, HF, and unstable angina. Complications of stress tests can be life-threatening. Stress test results may lead to further testing and procedures. Normally, the coronary arteries dilate to 4 times their size when metabolic demand increases. However, coronary arteries affected by atherosclerosis dilate less, compromising blood flow to the myocardium and causing ischemia. Abnormalities in cardiovascular function are more likely to be detected during times of stress (aka during a stress test). (679) It uses an EKG or nuclear imaging to screen for oxygenation/blood supply to the heart muscle. It determines the heart rate and blood pressures as well as the body's adaptation to stress. (742) o Since the modifiable risk factors for CAD mostly include lifestyle/dietary changes, it is important to begin (or continue) eating healthy.. In our book it discusses the "TLC Diet". In this diet it discusses what we need most of and what we need less of. It says 25%-35% of our total calories need to come from total fat. (<7% saturated fat, up to 10% total calories of polyunsaturated, and up to 20% of total calories in monounsaturated fats). Then it tells us that 50-60% of our total calories need to come from carbohydrates, 20-30 g/d need to come from dietary fiber, approximately 15% of total calories from protein and <200 mg/d of total calories need to come from cholesterol. This diet can of course be changed to fit individual needs.
o Another area of prevention is to engage in moderate-intensity aerobic activity of at least 150 minutes per week, or vigorous-intensity aerobic activity at least 75 minutes per week. Physical activity increases HDL levels and reduces triglyceride levels, decreasing the incidence of coronary events and reducing overall mortality risk.
o If diet alone cannot normalize the cholesterol levels, medications can aid in that. Lipid-lowering medications can reduce CAD mortality in patients with elevated lipid levels and in at-risk patients with normal lipid levels.
o One of the biggest ways to prevent CAD is too simply stop smoking.
o Managing hypertension- the risk for CAD increases as the BP exceeds 120/80. So, hypertension can be managed by eating healthier, exercise, and medications
o Managing Diabetes
o One potential complication is preload alterations which occur when too little blood volume returns to the heart as a result of persistent bleeding and hypovolemia. Preload can also decrease if there is a collection of fluid and blood in the pericardium (cardiac tamponade), which impedes cardiac filling. Cardiac output is altered if too much volume returns to the heart, causing fluid overload.
o Another potential complication is excessive postoperative bleeding, which can lead to decreased intravascular volume, hypotension, and low cardiac output. Bleeding problems are common after cardiac surgery because of the effects of CPB, trauma from the surgery, and anticoagulation.
o A third problem is afterload alterations. This occurs when the arteries are constricted as a result of postoperative hypertension or hypothermia, increasing the workload of the heart. Heart rate alterations from bradycardia, tachycardia, and dysrhythmias can lead to decreased cardiac output, and contractility can be altered in cardiac failure, MI, electrolyte imbalances, and hypoxia.
o Pathophysiology: an inflammatory response is initiated in response to injury to the vessel endothelium, which attracts inflammatory cells to the site. Fatty streaks are developed when macrophages ingest the lipids and become foam cells, depositing some lipids into the arterial wall. Once the lipids are deposited into the vessel wall, atheromas (plaques) are formed, which narrow the vessel and obstruct blood flow. A plaque can rupture and cause thrombus formation, and the thrombus can obstruct blood flow and lead to ACS or an MI.
o Clinical manifestations: depending on the location and degree of narrowing, obstruction to blood flow, and formation of thrombus causes certain symptoms. Symptoms include: angina pectoris (most common), less commonly epigastric distress, pain radiating to the jaw or left arm, shortness of breath, women have atypical symptoms like indigestion, nausea, numbness, palpitations.
o Treatment: Modifiable risk factors for coronary atherosclerosis are tobaccos use, cholesterol deviations, hypertension, and diabetes. So, it is important to treat these underlying conditions to treat coronary atherosclerosis. Treatments include: lowering total cholesterol, triglycerides, LDL, raising HDL, following the TLC diet if needed, quitting tobacco use, increase physical activity, managing hypertension, and controlling diabetes
o Pathophysiology: usually always caused by atherosclerotic disease and indicates obstruction of at least one major coronary artery. Insufficient blood flow results in decreased supply when there is increased demand (the demand outweighs the supply). Factors leading to angina pain include: physical exertion, exposure to cold, eating a heavy meal, and stress or emotion.
o Clinical manifestations: The pain is usually felt in the chest behind the sternum and can be localized to the neck, shoulders, jaw, and upper arms (usually left arm). Tightness or heaviness feeling is common, as well as numbness in the arms, SOB, pallor, lightheadedness, and n&v. The pain should subside with rest or nitroglycerin. Types of angina include: stable(relieved by rest or nitroglycerin), unstable (called preinfarction angina, pain frequency increases and may not be relieved with nitroglycerin or rest), intractable (incapacitating chest pain), variant (caused by vasospasm), and silent (evidence of ischemia without reports of pain).
o Treatment: Overall, the goal is to decrease the demand and increase the oxygen supply. Medications such as nitroglycerin, beta blockers, calcium channel blockers, and antiplatelets are used. Oxygen is administered to increase the amount of oxygen supply. An EKG is performed as well.
o Pathophysiology: Plaque ruptures and a thrombus forms, totally blocking the artery. This causes a huge imbalance between oxygen supply and demand. Ultimately, this leads to ischemia, and eventually necrosis.
o Clinical manifestations: most patients will have sudden chest pain that continues even with medication or rest. Other symptoms include SOB, indigestion, nausea, anxiety, tachycardia, tachypnea, and cool, pale, and moist skin.
o Treatment: Oxygen, aspirin, nitroglycerin, and morphine should be immediately given. A 12-lead EKG should be obtained within 10 minutes and cardiac biomarkers should be checked (especially troponin). A STEMI is treated with immediate PCI within 60 minutes. When PCI is not available, thombolytic therapy is indicated.
o The nurse assesses for signs and symptoms of heart failure and emboli, listens for changes in heart sounds at least every 4 hours, and provides the patient with the same care as for postprocedure cardiac cath and angioplasty.
o Patient will be sent to the ICU. Care for this patient will focus on recovery from anesthesia and hemodynamic stability.
o vital signs are assessed every 5-15 min and as needed until pt recovers from anesthesia or sedation and then are assessed every 2-4 hours and as needed.
o Assess radial, tibial, and dorsalis pedis pulses
o IV med to increase or decrease blood pressure and to treat dysrhythmias or altered heart rate are administered and effects are monitored.
o Assessments are conducted every 1-4 hours and as needed, with particular attention to neurologic, respiratory, and cardiovascular systems.
o After the patient has recovered from the anesthesia and come off the IV medication and is stable, the patient is transferred to the telemetry unit (usually within 24-72 hours)
o Nursing care continues such as wound care, pt education, diet, activity, meds, and self care.
o The nurse educated the patient on anticoagulant med and the importance of follow up appointments.
o involves blood flowing back from the left ventricle into the left atrium during systole. Most common causes are degenerative changes of the mitral valve and ischemia of the left ventricle.
o Pathophysiology- may result from problems with one or more leaflets, chordae tendinae, annulus, or papillary muscles. Regardless of cause, blood regurgitates into the atrium during systole. With each beat of the left ventricle, blood is forced back into the left atrium, adding to blood flowing in from the lungs. This causes the left atrium to stretch and eventually hypertrophy. The lungs become congested, eventually adding extra strain to the right ventricle. The volume overload causes ventricular hypertrophy. Eventually, the ventricle dilates and systolic heart failure develops.
o Clinical Manifestations- Chronic mitral regurgitation is often asymptomatic. Acute mitral regurgitation usually manifests as severe congestive heart failure. Dyspnea, fatigue, and weakness are the most common symptoms.
o Management- Same management as for heart failure. Patients benefit from afterload reduction by treatment with ACE inhibitors or angiotensin receptor blockers and beta blockers. Patients need to restrict his or her activity level to minimize symptoms. Symptoms are also an indicator for surgical intervention by mitral valve valvuloplasty or valve replacement.