Q9 from study guide for N2 final

Most serious complications of untreated cardiac problems.
CHF- Renal Failure, Arrythmias, Left Ventricular Thrombus, Hepatomegaly, Pleural Effusion
Increased O2 needs anywhere, metabolic needs anywhere and/or increased vascular resistance, causes heart to work harder, wear out and fail. (African Ams. have higher incidence of and less reponse to ACE inhibs)
Risk Factors- Hypertension, Heart disease (CAD, MI), Diabetes, Age, Obesity, Habits (sedentary lifestyle, smoking) High serum cholesterol, alterations in afterload, preload, HR,CO and contractility of heart.
Precipitating Factors- Stress, arrythmias, Infections, Anemia, Thyroid disorders, Myopathies, Pregnancy, Paget's disease (of bone and breast), Nutritional deficiencies, Pulmonary diseases, Hypervolemia, Sepsis
S/Sx- (objective)BP:decreasing systolic; narrowing pulse pressure, Pulse:alternating strong-weak, increased, Respirations: crackles, Edema: dependent pitting (1+ to 4+), Liver: enlarged, tender, Neck veins: distended, CXR: cardiac enlargement, dilated pulmonary vessels, diffuse interstitial lung edema,
(subjective)SOB, paroxysmal nocturnal dyspnea(sudden breathlessness at night), orthopnea(sleeps on multiple pillows), dyspnea on exertion (climbing stairs), Apprehension, Anxiety, Irritability, Fatigue, Weakness
Remember:
Right side=edema in body and organs
Left side=edema in lungs

Hypertension- increased peripheral resistance leading to thickened arteriole walls and left ventricualr hypertrophy
Risk Factors- African American, birth control pills, overweight, smoking, stress, excess sodium intake, lack of activity
S/Sx- (objective) Systolic >140, diastolic >90, narrowed pulse pressure(subjective)There are no subjective signs for Primary (essential)-SILENT KILLER !
Secondary there are problems related to other conditions (renal, endocrine, neurogenic, pregnancy, drug induced, caffeine, ETOH, misc. and/or cardiac)-early morning headache, light headedness, tinnitis, palpitations, fatigue, insomnia, forgetfulness, irritablity, altered vision (white spots, blurring, or loss), retinal narrowing or hemorrhages, abdominal bruits, inequal pulses, nosebleeds

Angina- pathophys-coronary occlusion- cyanotic myocardium (within 10 sec)-with total occlusion contractility ceases (within several min)-depriving myocard cells of glucose-lactic acid builds-irritates nerve endings- transmit pain message to cardiac nerves and upper thoracic roots-referred pain to left shoulder and upper arm etc.
Etiology Stable- usually MI r/t atherosclerosis
Etiology Unstable- Rupture of thickened plaque, exposing thrombogenic surface
Risk Factors- Same as MI and athlerosclerosis, high serum LDL, low HDL, high triglyc, heart disease, hypertension,etc
S/Sx-
Stable-predictable,can be controlled with meds-outpatient
(objective) ST depression or elevation and/or T wave inversion during pain on EKG, restlessness, cool clammy pale skin,arrythmias (esp. vent), up or down BP, pretty much same as MI
(subjective) substernal episodic pain 5-15 min, provoked by exertion, relieved by rest and/or nitro,pain mild-severe, SOB, pressure, ache,squeezing, constrictive, heavy, choking, suffocating, sharp, tingling, poss. radiating to neck, jaw, arms, back, causes anxiety

Unstable-unpredictable,hospitalization,
(objective) same as stable
(subjective) new onset, increasing frequency, duration or severity, occurs at rest or minimal exertion, pain refractory to nitro(comes back when nitro wears off) other sympts same as stable
Interventions- assess pain first, bed rest, MONA (O2 (2 liters), ASA, Nitro, Morphine),EKG,
At home-Nitro-5 min-Nitro-5 min-Nitro-5min-911
Tests- EKG ( normal at rest), stress test, cardiac enzymes and troponins (normal),cardiac cath

A-Fib- Irritable cells in atria with multiple sites initiating electrical impulses. Results- not a complete depol, quivering atria, loss of full atrial contraction and kick,an occasional pulse makes it through the AV node and then the ventricals contract, can cause ventricular dysrhythmias(bad)
Risk factors-mural thrombi,HF, COPD, pericarditis, MI, pulmonary embolus, thyrotoxicosis, rheumatic heart disease, hypertension, mitral stenosis, atrial irritation, complications of coronary bypass or valve replacement surgery
S/Sx-
(objective)R-R irreg, pulse irreg, no discernable P waves, QRS normal(<.12)looks same upside down or right side up
(subjective) depends on the ventrical response,
Interventions- O2, anticoags, card meds (to control vent rhythym and CO), prepare for cardioversion(if needed), Instruct in use of meds as prescribed to control dysrhythmia