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CARDIAC REHABILITATION

TEACHING GUIDE IN RESUMPTION OF


SEXUAL ACTIVTIY

CLUE: able to climb two flights


of stairs without dyspnea, chest
pain and other abnormalities
Assume less fatiguing
positioning (non MI partner on
top)
If both are MI patients: Side
lying
Perform activity in a cool,
familiar environment, early in
the morning
Take nitroglycerine before sex
Refrain from sexual activity
during a fatiguing day, after
eating a large meal

DISCHARGE PLANNING
1. Inform patient & family about
the dse.
2. Instruct pt. on how to judge
bodys response to activity
3. Activity programs:
Walking= gradual & no
lifting
Avoid extreme temp
Avoid stressful activity
4. Sexual Intercourse resume if
tolerated (4-8 weeks after)
5. 8 hours of sleep
6. Small frequent feeding
7. Limit visitors
8. Avoid smoking & caffeine
9. Lifestyle modifications

CONGESTIVE HEART DISEASE


DEFINITION:
Inability of the heart to pump
sufficient blood to meet the needs of
the tissue for oxygen and nutrients

SYNONYMS:

Cardiac Decompensation
Cardiac Insufficiency
Ventricular Failure
High output vs Low Output
Failure
High Output Failure

Heart functions may be supranormal


but inadequate owing to excessive
metabolic needs
E.g . Severe anemia, thyrotoxicosis

Low Output Failure


Impaired pumping ability of the
heart
E.g. Ischemic heart disease and
cardiomyopathy

Diastolic vs Systolic Failure


SYSTOLIC failure
Impaired EJECTION of blood
from the heart during systole
Problem in contractile
performance; Diseases leading
to volume and pressure
overload

DIASTOLIC failure
Impaired FILLING of the ventricles
during diastole
Smaller ventricular chamber size,
ventricular hypertrophy, ventricular
compliance

Right Sided vs Left Sided


Failure
RIGHT SIDED HEART FAILURE
PERIPHERAL EDEMA
DEFINITION: Results in peripheral
congestion d/t the inability of the
right ventricle to pump blood out of
the lungs. Often results from left sided
failure or pulmonary disease

CARDIOVASCULAR FINDINGS

Cardiomegaly

CONFIRMATORY TEST

2D ECHO

CAUSES:
Restriction of blood flow in the lungs
Stenosis or regurgitation of the
tricuspid or pulmonic valves
Right ventricular infarction
Persistent left sided failure
LEFT SIDED HEART FAILURE

Predisposing Factors:

Nursing Assessment

PULMONARY EDEMA

DEFINITION: Results in pulmonary


congestion d/t inability of the left
ventricle to pump blood to the
periphery

CAUSES:
Acute myocardial infarction
Cardiomyopathy

MANIFESTATIONS

Cyanosis
Cachexia and Malnutrition
Respiratory Manifestation
-Dyspnea
-Orthopnea
-Paroxysmal nocturnal
dyspnea
-Chronic dry non productive
cough
Fluid Retention and Edema
-Nocturia

Ischemic Heart Disease


Myocardial Infarction
Cardiomyopathy
Valvular Heart Disease

Observe for signs associated


with Left sided or right sided
failure
Enlargement of ventricles after
indicated by chest xray

Nursing Plans and Interventions

Measure abdominal girth,


observe ankles and fingers
Limit sodium intake
Fluid restriction
Check apical pulse prior to
administration of digitalis
Administer diuretics in morning
if possible
Provide periods of rest

MEDICATIONS
Meds: ACE inhibitors; diuretic
therapy; digitalis

Oxygen
Lasix

MSO4
Nitroglycerine
ACE inhibitors

Diet: Low sodium diet; avoidance of


excessive fluid intake

-localizes the site of vascular


obstruction and evaluates the degree
of narrowing
Patient Preparation
-Supine position with head elevated at
20 30 degrees, the legs are
externally rotated to permit adequate
access to the medial malleolus
COMPUTED TOMOGRAPHY SCAN

THROMBOEMBOLISM
EMBOLUS plug, composed of a
detached thrombus or vegetation,
mass of bacteria, or other foreign
body, occluding a vessel
THROMBUS OUTCOMES
A thrombus may:
Propagation: continue growing
by the accumulation of more
platelets and fibrin.
Embolization: dislodge and
travel to other parts of the
circulation where it occludes a
vessel. This is know
Dissolution: dissolve and is
gradually removed from the site
Organization and
Recanalization: trigger
inflammation and fibrosis and
vascular flow may be reestablished to this fibrous
tissue.

-provides cross sectional images of


soft tissue and can identify the area of
volume changes to an extremity

Nursing interventions:
NPO, if with contras medium
Ascertain history to iodine and
seafoods
Assess for claustrophobia
Assess to remain still
Sedate if unable to remain still
MAGNETIC RESONACE IMAGING
-performed with a standard MRI
scanner but can specifically isolate the
blood vessels; does not use a contrast
agent
ANGIOGRAPHY

DOPPLER ULTRASONOGRAPHY

Patient Preparation:
(Before)
-NPO 2-6 hours
-Assess for allergy to seafood and
iodion
-Mild sedative is adm.
-Local anesthesia at injection site (a
brief flushing feeling when the
contrast medium is injected)

-use of a probe that emits high


frequency sound waves moved over a
skin surface

D DIMER
-a product of fibronolysis, elevated in
venous thromboembolic

DIAGNOSTICS/ LAB STUDIES

RISK FACTORS FOR THROBOEMBOLISM


Circulatory conditions
Hypertension
Atherosclerosis
Aging
Diabetes
History of thromboembolism
Blood vessel condition
Pregnancy
Smoking

Venous vs Arterial Thrombosis


Venous Thombosis
Deep vein thrombosis (DVT) is
an example of a thrombus
which occurs in the deep calf
veins of the legs but may
extend upwards to the popliteal,
femoral and iliac veins
Arterial Thrombosis
Occurs when coronary arteries
become occluded as a result of
plaque formation (endothelial
damage/alteration to blood
flow) and can lead to a
myocardial infarction (heart
attck)
Symptoms of peripheral
embolism:
Paresthesias
Tingling
Numbness
Pain
Weakness
Weak pulse
Symptoms of brain embolism:
Stroke- like symptoms
Symptoms of GI embolism:
Severe abdominal pain
Nausea
Vomiting
Shock

Nursing Management
Bed rest
Avoid prolonged sitting;
standing
Warm moist packs
Walking
Elevation
Elastic compression stocking
Maintain ideal body weight
Measure thigh and calves once
a day
Management

Emergency hospitalization
Surgery
Bypass surgery
Anticoagulant
Aspirin
Vasodilators

PERICARDIA EFFUSION
DEFINITION: An abnormal amount or
character of fluid within the
pericardial sac
Function: evenly distribute force
across the heart
Normal levels of pericardial are
from 15 to 50ml
CAUSES:

Pericarditis
Viral infection (coxsackie virus)
Infection
Inflammatory disorders
Cancer that has spread to the
pericardium
Heart surgery

Symptoms:

Classic beck triad


(Hypotension, Distended
neck veins and Muffled
heart sounds)
Pulsus paradoxus
Pericardial friction rub
Tachycardia/pnea
Decreased BS
Hepatosplenomegaly
Weakened peripheral pulses
Edema , cyanosis

Pericardial window
(Subxyphoid
pericardiostomy)

CARDIAC TAMPONADE
-accumulation of fluid in the
pericardium in an amount sufficient to
cause serious obstruction to the inflow
of blood to the ventricles
-severe compression of the heart that
impairs its ability to function
LIFE THEATENING
MEDICAL EMERGENCY

Diagnostic

Chest x-ray
CT scan
Echocardiogram

Medical Management
The goals of medical management
Treat the underlying cause
Nonsteroidal anti-inflammatory
medications
Chemotherapy, radiation
therapy
Diuretics and cardiac meds for
pericardial effusions caused by
heart failure
Antibiotics
MED MGT.

Ultrasound guided
pericardiocentesis
Video assisted
thoracoscopic surgery
(VATS)

Predisposing Factors
Blunt or penetrating trauma to
the chest
Iatrogenic factor (post dx or
surg procedure)
Neoplastic Disease
Idiopathic pericarditis
Clinical Manifestation
Feeling of fullness within the
chest
Faintness; Anxiety
Shortness of breath; Cough
Pain
Pulsus paradoxus
BECKS TRIAD
Confirmatory Test
Echocardiography
Management:
-Administer oral or IV diuretics as
prescribed
-Closely monitor fluid status
-Administer O2 as prescribed
-Closely monitor VS
-Provide cal and restful environment

CARDIOGENIC SHOCK

Extreme form of heart failure

Occurs when the heart is unable


to contract with adequate force
to deliver a cardiac output
normal to meet metabolic
demands
Mortality rate more than 80%

CAUSES:
MI most common cause
Cardiomyopathy
Cardiac tamponade
Restrictive pericarditis
Pulmonary embolism
Server vavular heart disease
Manifestation:
Tachycardia
Dyspnea
Hypertension
Hypotension (late sign)
Mild to severe decrease in urine
output
Decrease mentation
Moist clammy
Changes in LOC
CRT more than 3 seconds
Metabolic Acidosis
Poor Tissue perfusion
(Oliguria, Cyanosis, Cool Extrem)
Management
Goal:
Improve cardia output
Reduce myocardial workload
and oxygen consumption
Preserve coronary perfusion
Management
Monitor hemodynamic status
-fluid intake
-VS
-Maintain patency of swan
ganz catheter
O2 therapy
Treat underlying cause

Pharmacologic
Inotropics to improve cardiac
contractility
Vasodilators
Diuretics