pccn review - adult critical care nursing conferences – complications ... pericardial effusion ......
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10/16/2014
21
Hypertrophic (IHSS)
Diagnosis
Chest x – ray cardiomegaly
Electrocardiography LV hypertrophy, ST segment T
was changes, Q waves in inferior & precordial leads
Atrial & ventricular dysrhythmias
CCRN Review - Cardiovascular
Hypertrophic (IHSS) Diagnosis
Echocardiography Narrow LV outflow tract Thickened septum Decreased LV chamber
Cardiac catheterization Decreased LV compliance Mitral regurgitation Hyperdynamic systolic function LV outflow obstruction
CCRN Review - Cardiovascular
Hypertrophic (IHSS)
Management - general
cardoiversion for AF
IABP
fluid & sodium restriction
O2 therapy
rest & exercise restrictions
CCRN Review - Cardiovascular
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Hypertroophic (IHSS) Management
- adrenergic blockers
antimicrobials
CCRN Review - Cardiovascular
Hypertropohic (IHSS) Management – complications
mural thrombus
pulmonary embolus
severe heart failure
sudden cardiac death
CCRN Review - Cardiovascular
Restrictive Introduction
fibrous infiltration of heart
heart becomes noncompliant
preload & contractility diminished CO
CCRN Review - Cardiovascular
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Restrictive Clinical Presentation
chest pain fatigue weakness dyspnea, orthopnea, PND
crackles right – sided symptoms
CCRN Review - Cardiovascular
Restrictive
Diagnosis
Chest x – ray cardiomegaly
Electrocardiography Low QRS voltage
AV blocks
CCRN Review - Cardiovascular
Restrictive Diagnosis
Echocardiography Atrial enlargement Enlarged ventricular outside dimension; small ventricular chamber
Cardiac catheterization Elevated LVEDP,RVEDP, PAOP, RAP
CCRN Review - Cardiovascular
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Restrictive Management -CHF
O2
ACE inhibitor
vasodilators
diuretics
inotrope
CCRN Review - Cardiovascular
Restrictive Management - complications
dysrhythmias
AV blocks
systemic emboli
consider transplantation
CCRN Review - Cardiovascular
Endocarditis Introduction
acute
subacute
IV drug users
prosthetic valve
CCRN Review - Cardiovascular
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Endocarditis Risk Factors
prosthetic cardiac valves
previous bacterial endocarditis
congenital malformations
CCRN Review - Cardiovascular
Endocarditis Risk Factors
rheumatic heart disease
mitral valve prolapse
indwelling IV devices
dental or surgical procedures
CCRN Review - Cardiovascular
Endocarditis Clinical Presentation
fever, chills & fatigue (25% to 80%)
embolic phenomenon (50%)
skin: petechiae, Osler nodes, splinter hemorrhage, Janeway lesions
splenomegaly
CCRN Review - Cardiovascular
10/16/2014
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Endocarditis Management
culture & sensitivity antimicrobials
vancomycin + rifampin + gentamicin
rafcillin or oxacillin + gentamicin
penicillin + gentamicin
CCRN Review - Cardiovascular
Pericarditis Definition
inflammation of pericardium
variety of etiologies
CCRN Review - Cardiovascular
Pericarditis Etiology
infections
MI
traumatic
mediastinal radiation
CCRN Review - Cardiovascular
10/16/2014
27
Pericarditis Etiology
uremia neoplasm rheumatic fever other: anticoagulants, ITP
CCRN Review - Cardiovascular
Pericarditis Clinical Presentation
severe constant pain pain intensifies with inspiration
pain relieved by sitting up & leaning forward
pericardial friction rub
CCRN Review - Cardiovascular
Pericarditis Diagnostics
CBC with differential, BUN & creatinine, cardiac enzymes
ECG
Chest x – ray
CCRN Review - Cardiovascular
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Pericarditis Management
Limit activity
Patient education regarding complications
CCRN Review - Cardiovascular
Pericarditis Management
Anti – inflammatory agents NSAIDS
Corticosteroids
Ventricular rate control
CCRN Review - Cardiovascular
Pericarditis Management - complications
pericardial effusion
chronic constrictive pericarditis
cardiac tamponade
CCRN Review - Cardiovascular
10/16/2014
29
Aortic Disruption Introduction
intimal tear allows blood to dissect between medial layer of the aorta
peak incidence in 6th & 7th decade
classified as Type A & Type B
CCRN Review - Cardiovascular
Aortic Disruption
Etiology
atherosclerosis
connective tissue diseases
hypertension
CCRN Review - Cardiovascular
Aortic Disruption
Thoracic
chest pain (radiates)
syncope (12%)
hypo- or hypertension
unequal or absent pulses
CCRN Review - Cardiovascular
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30
Aortic Disruption
Thoracic
murmur of AI
neurologic changes
mass effect
cardiac tamponade
CCRN Review - Cardiovascular
Aortic Disruption
Abdominal
asymptomatic
pulsatile epigastric mass
vague abdominal pain (may radiate to back)
CCRN Review - Cardiovascular
Aortic Dissection Diagnostics
Ultrasound
CT scan
aortogram
CCRN Review - Cardiovascular
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CCRN Review - Cardiovascular
CCRN Review - Cardiovascular
Aortic Dissection Treatment
Surgical repair
Endovascular repair
CCRN Review - Cardiovascular
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Aortic Dissection Prognosis
> 7 cm 75% risk 6 – 7 cm 35% risk 5 – 6 cm 25% risk 0 – 5 cm low risk
CCRN Review - Cardiovascular
Pericardial Tamponade
Introduction
accumulation of blood
in the pericardial sac
etiology = blunt &
penetrating trauma
CCRN Review - Cardiovascular
Pericardial Tamponade
Signs & Symptoms
dyspnea
cyanosis
Beck’s triad
pulsus paradoxus
shock symptoms
CCRN Review - Cardiovascular
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Pericardial Tamponade
Interventions
pericardiocentesis
open thoracotomy
operative intervention
CCRN Review - Cardiovascular
Cardiac Contusion
Introduction
bruising of the heart tissue
myocardial ecchymoses to
myocardial infarction
etiology = blunt trauma
CCRN Review - Cardiovascular
Cardiac Contusion
Signs & Symptoms
chest pain similar to MI
chest wall ecchymoses
S3 or crackles in lung
dysrhythmias, ECG changes
elevated CPK, troponin
CCRN Review - Cardiovascular
10/16/2014
34
Cardiac Contusion
Interventions
same treatment as for MI
monitor CO & CV status
monitor for life-threatening dysrhythmias for 24 - 48 hours
CCRN Review - Cardiovascular
Cardiac Contusion
Complications
cardiac tamponade
cardiogenic shock
myocardial rupture
valve injuries
constrictive pericarditis
CCRN Review - Cardiovascular
Definition - Shock
cell hypoxia related to decreased perfusion
potentially fatal if not identified & treated
CCRN Review - Cardiovascular
10/16/2014
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Categories hypovolemic cardiogenic distributive obstructive
CCRN Review - Cardiovascular
Initial Stage cellular changes
no initial signs or symptoms
CCRN Review - Cardiovascular
Initial Stage glucose lactate level base deficit pHi
CCRN Review - Cardiovascular
10/16/2014
36
Compensatory Shock Neural (fight or flight)
Hormonal
Chemical
CCRN Review - Cardiovascular
Progressive Shock Failure of compensatory
mechanisms
Brain Kidneys
GI Tract Liver
Pancreas Lungs
Myocardium
CCRN Review - Cardiovascular
Refractory Shock Progression to multiple
organ failure
Cardiac Failure
Acidosis
Blood Clotting
Cerebral Ischemia
CCRN Review - Cardiovascular
10/16/2014
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Hypovolemic most common type of shock
compromise in systemic perfusion
diminished circulating volume
CCRN Review - Cardiovascular
Hypovolemic Causes
absolute blood loss fluid/electrolyte loss third spacing redistribution of volume endocrine
CCRN Review - Cardiovascular
Hypovolemic Goals
ABCs
stop source of loss
restore intravascular volume
CCRN Review - Cardiovascular
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Hypovolemic
Type of replacement
dehydration = isotonic
hemorrhagic = isotonic & possibly blood products
3rd spacing = isotonic & possibly colloid
CCRN Review - Cardiovascular
Hypovolemic
Adverse Effects
hypothermia
hyperkalemia
acidosis or alkalosis
clotting problems
intravasculsar debris
CCRN Review - Cardiovascular
Cardiogenic
reduction in flow of O2 to myocardium
demand > supply
diminished contractility diminished CI
CCRN Review - Cardiovascular
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Cardiogenic myocardial infarction dysrhythmias severe electrolyte disturbances
drug toxicity advanced septic shock
CCRN Review - Cardiovascular
Cardiogenic CV surgery CHD (AS) cardiomyopathy acid-base imbalances cardiac contusion
CCRN Review - Cardiovascular
Cardiogenic Goals of Therapy
Increase Cardiac Output
CCRN Review - Cardiovascular
10/16/2014
40
Cardiogenic
Increase contractility
Decrease afterload
Optimize preload
Optimize heart rate
CCRN Review - Cardiovascular
IABP Concepts
Balloon inflation Balloon deflation
CCRN Review - Cardiovascular
IABP Complications
Limb perfusion Contraindications Pulseless patient
CCRN Review - Cardiovascular
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