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Cardiac Disorders - Teach Back

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on 5 November 2013

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Transcript of Cardiac Disorders - Teach Back

Hypertension
Cardiac
Disorders
Danielle Glover - CAD
Harpreet Kaur - HTN
Elizabeth Meadows-Kraus
Shweta Mehra - mi
Rujuta Shah

Heart Disease is the
#1 Killer in the U.S.
What is it?
Pathophysiology

Normal BP is when the heart contracts and puts pressure on blood vessels so blood can flow freely.

Hypertension is the increase in CO plus the increase in PR.



Diagnosis
-BP screening
-Eye exams
-Lab tests: urinalysis, blood chemistry
-EKG
-Echocardiogram

"Silent Killer"
Medical Management
-GOAL: Prevent complications by keeping BP at 140/90 or less
-Goal for diabetics and kidney disease" 130/80
-Lifestyle modifications
-Pharmacologic therapy

What is it?
-Definition: constricted arterial blood vessels increase the resistance to blood flow, causing an increase in
pressure against vessel walls

-Expressed as two numbers: S/D
Systolic pressure= heart contracts
Diastolic pressure= heart relaxes
Types
Primary hypertension:
HTN from unidentified cause

Secondary hypertension:
HTN from an identified cause

Risk Factors
-Increased SNS activity

-Increased renal reabsorption

-Increased RAAS system

-Decreased vasodilation
of arterioles

-Resistance to insulin





















-Smoking
-Dyslipidemia
-Diabetes Mellitus
-Impaired renal function
-Ethnicity: High in African Americans
-Lifestyle: Inactivity, Obesity
-Increasing age
-Family History
Causes
Complications
-Heart Disease (more later)
-Stroke
-Kidney Damage
-Vision Loss

Signs and Symptoms
-Diuretics
(Thiazide, loop, K-sparing)
-Ace inhibitors
-ARBS
-B-blockers
-Alpha1- Blockers
-Ca Channel Blockers
(Nondihydropyridines,
Dihydropyridines)
-Vasodilators

Nursing Management
Nursing Interventions
Assessment:
-Careful monitoring of BP
-Anti-hypertensive treatment
-Collect complete health history
-Physical exam
Planning/Goals
-Educate patient
Implement
-Lowering and controlling blood pressure
-Provide educational materials

Evidence-Based Practice
CAD: Coronary Artery Disease
What is it?
Coronary artery disease is the narrowing or blockage of the coronary arteries, usually caused by atherosclerosis.


Non-modifiable
-Smoking
-Exposure to tobacco smoke
-High LDL cholesterol
-High triglyceride
-Uncontrolled diabetes
-Physical inactivity
-Being overweight (BMI >25)
-Uncontrolled stress or anger
-Diet high in sat. fat
-Too much alcohol

-Male gender
-Advanced age
-Family history of heart disease
-Race: African Americans, Mexican Americans, Indian Americans, Native Hawaiian, and some Asian Americans

Signs and Symptoms
-Angina – most common
-SOB
-Palpitations
-Increased HR
-Dizziness
-Nausea
-Extreme weakness
-Sweating

Diagnosis
Diagnostic Tests
-Blood tests
-ECG or EKG
-Exercise stress tests
-CT scan
-MRA
(magnetic
resonance
angiography)

Cardiac Cath
-Catheter is inserted into the right or left side of the heart



Nursing
Management
Before Procedure:

-NPO status
-Preprocedure meds
-Pulses
-D/c Metformin 48 hours prior
After Procedure:
-Lie flat for 3-6 hours
-Frequent VS
-Check site q15 min
-Check distal extremity circulation
-Encourage fluid intake
-Teach pt to check for infection
-No tub baths or exercise for 2-3 days

CAD Treatment
Angioplasty, Stent Replacement
-Insert catheter into narrow part of artery.
-A wire with a balloon in inflated, compressing the deposits against the artery walls.
-Stent is often left in the artery to help keep the artery open.

Coronary artery bypass graft (CABG)
A graft is created to bypass blocked coronary arteries
using a vessel from another part of your body.

Provides blood flow beyond the stenosis. This surgery is reserved for multiple narrowed coronary arteries.

Medications
Cholesterol modifying meds, (Statins, Niacin, Bile acid sequestrants), Nitroglycerin, Aspirin, BB, ACE, ARBs, and CCB

Nursing Management
Education
-Reduce risk factors
-Smoking cessation
-Diet changes to reduce
cholesterol, sodium, and fat
limit alcohol intake.
-Increase exercise and
activity level

Unstable plaque buildup in the coronary arteries can cause a...
Myocardial Infarction
What is a MI?
Ischemia, Injury, Infarction
Symptoms
Diagnosis
1. Thallium scans
-Assesses for ischemia
or necrosis
via radioisotopes
-“Cold spots” =
decreased or absent perfusion

2. Plasma biochemical markers
-CK-MB – levels not evident after 24 hr
-Myoglobin – levels not evident after 3 days
-Troponin I – levels not evident after 7 days
-Troponin T – levels not evident after 14-21 days


3. Cardiac Cath

4. History

5. EKG
Medical Management
What is happening?
When the blood vessel walls are damaged due to HTN, cholesterol will start to accumulate there and lead to...
Medications
-Vasodilators -Nitro
-Analgesics – Morphine sulfate
-Beta-blockers – Lopressor
-Thrombolytic agents – Streptokinase (Streptase) and alteplase (Activase)
-Antiplatelet agents – Aspirin and Plavix
-Anticoagulants – Heparin and Lovenox
Surgical
Interventions
-PTCA
-CABG
-Pacemaker
Emergency
Management

1. Oxygen

2. Aspirin

3. Nitro

4. Morphine

*MONA - is the wrong order
Nursing Management
-Monitor vital signs every 15 mins until stable, then every hour
-Serial ECG
-Assess pain
-Hourly urine output
-Lab data (cardiac enzymes, electrolytes, ABGs)
-Administer oxygen (2-4L)
-Obtain and maintain IV access
-Promote energy conservation (cluster nursing interventions)

Severe MI can lead to...
Educate! Prevent!

-Lifestyle modifications
-Explain drug therapy
-Control diabetes and hypertension

Heart Failure
Pathophysiology
Heart fails to act as a pump-->
Dec CO, backward flow, workload increased
Causes
-CAD
-Cardiomyopathy
-Endocarditis
-MI
-Valvular disorders

*Primary cause: HTN

Signs and Symptoms
Diagnosis
-BNP
-CXR
-PA Cath
-A-line
-Echo
Medical
Management
Medications
-Digoxin - Normal level: 0.05-2 ng/mL
-Diuretics - Lasix - decreases preload

-Ace inhibitors - decreases afterload
-B- blockers decreases afterload

-Treat cause: Valvular Surgery, CABG, Pacemaker,
-LVAD
-Heart transplant

Nursing
Management
-Low Na diet
-Restrict fluids
-Elevate HOB
-I&O/daily wt delegate!
Interventions:
Evidence-Based Practice
-Telehealth

-Daily weight logs
teaching handouts
teachable moments

-Self care discharge
instructions
(Brunner & Suddarth, 2011)
Retrieved from: http://yeehoo224.wordpress.com/2012/01/28/
Retrieved from: pathophysiology530.weebly.com
Retrieved from: http://pdxrecycler.wordpress.com/2011/04/29/prescription-bottles/
Retrieved from: http://www.ellies-whole-grains.com/flax-seed-and-cholesterol.html#axzz2fYct3NLC
Retrieved from: http://www.msichicago.org/education/live-from-the-heart/overview/about-lfth/heart-disease/
Retrieved from: http://uvahealth.com/services/heart/treatment/11986

Retrieved from: http://www.thirdage.com/hc/c/coronary-artery-disease-cad-symptoms

Retrieved from: http://www.mainlinehealth.org/oth/Page.asp?PageID=OTH005434

Retrieved from https://uvahealth.com/services/heart/treatment/14783


Retrieved from: http://www.wregional.com/CoronaryArteryBypassGraftingCABG

Retreived from: http://www.walgreens.com/marketing/library/contents.html?docid=000003&doctype=10
Retrieved from: http://www.pennmedicine.org/health_info/cholesterol/000235.html
Retrieved from: http://comeoutwhenyourehappy.blogspot.com/2013/04/how-to-lower-cholesterol-without.html

Retrieved from http://nurse.ayuda-por-favor.com.ar/ ii-medical-surgicalnursing.iii cardiovascularhealth.13 cardiacdisorders.htm

Retrieved fromL http://www.health-medicine.ch/doctor Myocardial_infarction.html
Retrieved from http://www3.telus.net/emergency/mi/zones.htm

Warning Signs Of A Heart Attack. (n.d.). Retrieved September 20, 2013, from http://t2.gstatic.com/ images?q=tbn:ANd9GcT0PuQEiNLcL6eTFGGW9ZwcC2-s2cYfc3pQxsQmbZigpVyoknH3LQ

Retrieved from: http://healthlob.com/2011/07/heart-attack-symptoms
Retrieved rom: http://hezronkyle.wordpress.com/2012/08/27/location-of-chest-pain-during-angina-or-heart-attack


Swan Ganz Cathether or PA Cath
Retrieved from: www.onxlti.com
Retrieved from: http://www.covenantheartinstitute.com/default
Retrieved from: http://www.shutterstock.com/pic-3194626/stock-photo-asian-chinese-mid-adult-female-medical-practitioner-checking-blood-pressure-of-african-american.html?src=p-78736825-7
Retrieved from: http://spectra.com.pe/edwards/specialy/Cardiology/swan_ganz_catheters_3.html
Retrienved from: http://healthportal.ca/homepage-products/cardiac-medications-and-nursing-series.html
Retrieved from: http://www.icumed.com/products/critical-care/pressure-monitoring-system/transpac.aspx
Retrieved from American Heart Association
Retrieved from: http://flplahore.blogspot.com/2012/09/www.distributorpakistan.com9.html
Retrieved from: http://www.mhealthtalk.com/2012/09/will-the-affordable-care-act-help-telehealth-flourish/
Retrieved from: http://evidence-based-practice.wikispaces.com/Evidence-Based+Practice
DASH diet AND Exercise = better outcomes
Blumenthal, J. A., Babyak, M. A., Hinderliter, A., Watkins, L. L., Craighead, L., Lin, P. H., ... & Sherwood, A. (2010). Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Archives of Internal Medicine, 170(2), 126.
Retrieved from: Blumenthal, J. A., Babyak, M. A., Hinderliter, A., Watkins, L. L., Craighead, L., Lin, P. H., ... & Sherwood, A. (2010). Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Archives of Internal Medicine, 170(2), 126.
(Brunner & Suddarth, 2013 (pg894)
Retrived from: http://www.lifefitness.com/home/cardio/treadmills/f1-smart-treadmill.html
Retrieved from: http://nextlevelfitnesscharleston.com/
Retrieved from: http://www.presentermedia.com/index.php?target=closeup&maincat=clipart&id=1770
Modifiable
Risk Factors
(Retrieved from CDC)
The End
Evidence-Based Practice
-Teach-back
What
Who - Is NOT a test of the patient but rather a test of how well you explained a concept
When - Start early
Why - Improves patient outcomes *pic
How
Closed communication loop
Do not say, "Do you understand?" or "Do you have any questions?"
Retrieved from: http://www.serenabydesign.com/wp-content/uploads/2012/03/Einstein.jpg
Retrieved from: www.ihconline.org
Retrieved from: http://www.allanwolf.com/visits/active-voice-workshop/teaching-poetry/
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