Chapter 29 Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders

Pericarditis Inflammation of the pericardium Many causes Nursing diagnosis: pain Potential complications Pericardial effusion Cardiac tamponade

Chapter 30 Management of Patients With Complications From Heart Disease Self-Review

Cardiac Hemodynamics CO = SV × HR Preload Afterload Contractility

Pathophysiology of Heart Failure

Collaborative Problems/Potential Complications Cardiogenic shock Dysrhythmias Thromboembolism Pericardial effusion and cardiac tamponade

Cardiogenic Shock A life-threatening condition with a high mortality rate Decreased CO leads to inadequate tissue perfusion and initiation of shock syndrome. Clinical manifestations: symptoms of heart failure, shock state, and hypoxia

Management of Cardiogenic Shock Correct underlying problem Medications Diuretics Positive inotropic agents and vasopressors Circulatory assist devices Intra-aortic balloon pump (IABP)

Intra-Aortic Balloon Pump

Thromboembolism Decreased mobility and decreased circulation increase the risk for thromboembolism in patient with cardiac disorders including those with Heart Failure. Pulmonary embolism: blood clot from the legs moves to obstruct the pulmonary vessels. The most common thromboembolic problem with heart failure Prevention Treatment Anticoagulant therapy

Pulmonary Emboli

Chapter 30 Management of Patients With Complications From Heart Disease

Pericardial Effusion and Cardiac Tamponade Pericardial effusion is the accumulation of fluid in the pericardial sac. Cardiac tamponade is the restriction of heart function due to this fluid resulting in decreased venous return and decreased CO. Clinical manifestations: ill-defined chest pain or fullness, pulsus parodoxus, engorged neck veins, labile or low BP, shortness of breath. Cardinal signs of cardiac tamponade: falling systolic BP, narrowing pulse pressure, rising venous pressure, distant heart sounds.

Medical Management Pericardiocentesis Pericardiotomy

Sudden Cardiac Death/Cardiac Arrest Emergency management: cardiopulmonary resuscitation A- airway B- breathing C- circulation D- defibrillation for VT and VF

Question What is the most reliable sign of cardiac arrest in an adult and child? Blood pressure Brachial pulse Breathing Carotid pulse

Answer D The most reliable sign of cardiac arrest is the absence of a pulse. In an adult or child, the carotid pulse is assessed. In an infant, the brachial pulse is assessed.