Tiêu đề REF - HANDOUTS - CARDIO (Ms. Pomentil) ✅

TOP RANK REVIEW ACADEMY, INC. Page 2 | 1 C. Percussion  Normal cardiac percussion:  D. Auscultation (Heart Sounds) • S1 (“lubb”) – closure of • S2 (“dubb”) – closure of • S3 (ventricular gallop) – rapid ventricular filling - - • S4 (atrial gallop) – abnormal in all ages • Auscultatory Locations: • Tricuspid Valve - • Mitral (Apical) Valve - • Aortic Valve - • Pulmonic Valve - 3. Common Clinical Manifestations a. Dyspnea  Dyspnea on Exertion  Orthopnea  Paroxysmal nocturnal dyspnea – b. Chest pain c. Edema d. Syncope e. Palpitations f. Fatigue 4. Diagnostic Tests A. CBC (general health status) - Elevated RBCs – suggests hypoxia - Elevated WBCs - may indicate B. Serum Cardiac Markers  Cardiac Enzymes • Aspartate Aminotransferase (AST) • Lactic Dehydrogenase (LDH) • Creatinine Phosphokinase (CK-MB)  Troponin I (most important, most indicative) - Protein found in myocardial cells; reliable critical markers of myocardial injury - N: - Remains elevated for as long as 2 weeks  Myoglobin – protein found in cardiac & skeletal muscle - Not very specific (negative result can rule out MI) C. Electrocardiogram (ECG) - records _________________ of the heart P Wave – Atrial depolarization QRS Complex – Ventricular Depolarization T Wave – Ventricular Repolarization
TOP RANK REVIEW ACADEMY, INC. Page 3 | 1 III. Disorders of the Heart A. Angina Pectoris - Transient chest pain caused by insufficient blood flow to the myocardium resulting in myocardial ischemia  Causes: - atherosclerosis - HPN - DM (viscous blood)  Manifestation 1. Pain S – A – V – E – R – S – 2. Other mx: pallor, diaphoresis, dyspnea, syncope, palpitations, dizziness  Precipitating Events of Angina Pectoris (4 E’s)  Exertion:  Emotions:  Eating a heavy meal  Environment:  Management:  Medical 1. Direct Vasodilators (Nitrates) • Nitroglycerine • ISMN (Isosorbide Mononitrate) • ISDN (Isosorbide Dinitrate) 2. Beta – Blockers: • Metropolol (Lopressor) • Propanolol (Inderal) • Atenolol (Tenormin) 3. Calcium - Channel blockers • Nifedipine (Procardia)  Amlodipine (Norvasc)  Nicardipine (Cardene)  Nursing Interventions in Drug Therapy  Nitroglycerine Therapy - drug of choice for pain relief - Take maximum of __________ at __________ interval; if not relieved - Indication of potency: ____________________ under the tongue when taken sublingually - Dry of mouth inhibit absorption: - Patient education: o Avoid: Alcohol o Gradual change of position o Always carry 3 tabs in pocket o Storage: (destroyed by heat, light or moisture) - - - - change stock every ____________ o Side Effects: headache, flushed face, dizziness, faintness, tachycardia - common: - instruct to:  Beta-Blocker Therapy - Prior adm: - Prevent GI upset:
TOP RANK REVIEW ACADEMY, INC. Page 4 | 1 - contraindicated with Propanolol (Inderal) o Asthma pts – o DM pts – - Antidote for BB poisoning:  Calcium channel blockers - Prior Adm: - food delay absorption: - Antidote for CCB poisoning: B. Myocardial Infarction (Heart Attack) - Formation of localized necrotic areas within the myocardium - Most common site:  Causes: - Coronary occlusion - Cessation of blood supply v Classifications of MI:  Subendocardial –  Intramural –  Transmural –  Manifestation 1. Pain – crushing, severe pain - radiating arms, neck and back - not relieved by rest and nitroglycerine - lasting - Universal sign of distress: 2. Feeling of “doom” 3. ECG:  STEMI – ST segment elevation  NSTEMI – Non ST segment elevation 4. Laboratories: - increased Cardiac Enzymes: - elevated Troponin levels:  Management: 1. Morphine – 2. Oxygen Therapy by cannula – 3. Nitroglycerine – 4. Aspirin (ASA) –  Nursing Interventions - Instruct client to avoid over fatigue - Position: - Bed rest o _______ commode; ________ bed pan o Use stool softener to avoid straining - Diet: - Provide psychosocial support to pt and family  Complication: C. Pericarditis - Inflammation of the pericardium  Causes: - May occur as a complication or cardiac surgery - May occur approx 1 week to 2 months post MI