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Brought to You by Look at You! You’Re Amazing! and You’Re Soon to Be Even More Amazing Since You’Re Taking Steps to Learn As Much As You Can in Nursing School MED SURG SUCCESS PACK brought to you by Look at you! You’re amazing! And you’re soon to be even more amazing since you’re taking steps to learn as much as you can in nursing school. You rock! By purchasing and downloading this e-book you agree to the terms and conditions, you understand that this is a reference guide and nothing here should be viewed as set in stone as research and medical practices change regularly. © 2019 Digital Health Media LLC. All content is the property of the Straight A Nursing website (www.straightanursingstudent.com) and Digital Health Media LLC. Replication and distribution of this material is prohibited by law. All digital products (PDF files, e-books, resources, online content and videos) are subject to copyright protection. Each product sold is licensed to a single user and customers are not allowed to copy, distribute, share or transfer the products (and any associated user names or passwords) purchased to any other individual or entity. Fines of up to $10,000 may apply and individuals will be reported to the BRN and their school of nursing if known. In some cases, Digital Health Media LLC may encrypt, force password and/or stamp license details which include customer name and e-mail into its digital products to ensure safety. This study guide is not intended to be used a medical advice; it is for educational purposes only. When details differ, please defer to specifics as outlined by your own facility or nursing program. Please send corrections, updates and comments to [email protected] CARDIOVASCULAR SYSTEM brought to you by CARDIOVASCULAR - MED/SURG 1 Key Concept The first thing to understand about the cardiovascular system is that the purpose of the entire system is to provide oxygen- ation and perfusion to the body. There are four concepts related to oxygenation and perfusion that you will see again and again. It is imperative that you understand these...they are: 1. Hypoxemia: decreased oxygen concentration of arterial blood 2. Hypoxia: oxygen deficiency in body tissues 3. Ischemia: tissue not getting enough oxygen 4. Necrosis: tissue death Overview Cardiovascular (CV) disease is the leading cause of death in the US. Some estimates show that one death occurs every 33 seconds, and 25% of the population has CV disease. Most of the patients you see in the hospital will have some kind of cardiovascular disease (and the sad part is, it is often preventable). Technology & Diagnostics How is CV disease diagnosed and treated? Glad you asked! Though there are advancements occurring all the time, the mainstays of testing and treatment are: EGG: This is your typical electrode-based diagnostic tool. This could be as few as three leads (or electrodes), and as many as 10 (which provides 12 views, so it’s called a “12-lead”). The electrodes create a graphic representation of the electrical impulses that the heart generates during the cardiac cycle. Don’t worry, we’ll go into this in much more detail in Med/Surg 2. Interfering factors are electrolyte imbalances and certain drugs such as digitalis, quinidine and barbiturates (also, if your patient is brushing his teeth, this looks like V-tach! Always assess your patient BEFORE you freak out!). Ultrasound (ECHO): Used to evaluate the structure and function of the heart. It’s not all that accurate in patients with COPD (due to a lot of air between the heart and chest cavity) and patients who are obese. Stress Test: A stress test is exactly what it sounds like...the heart is tested while under stress. The first part of the test is called the “resting” portion, which is essentially an EGG conducted while the patient is resting. The “stress” portion is done next for purposes of comparison. Most patients will undergo the stress portion by simply walking on an inclined treadmill (in some cases, they may have to actually jog a little in order to get the heart rate up), but what about patients who are too sick or disabled to ambulate safely? Those folks can still get their stress test, but the stress is chemically induced. And yes, it should make you a wee bit nervous because these are very powerful drugs! The patient is injected with a medication that will make their heart beat faster while the technician records everything on the EGG. The most commonly used medications are adenosine, dobutamine or dipyridamole (Persantine). We’ll talk about these more in the Advanced Med/Surg section. Angiography: Also known as a “heart cath” or, if you want to be fancy, then call it by its full name of “cardiac catheterization.” Whatever you call it, this is an invasive procedure used to 1 STRAIGHTANURSINGSTUDENT.COM visualize the heart chambers, arteries and great vessels. It is used most often to evaluate patients with chest pain and patients who have had a positive stress test to locate the region of coronary occlusion. It is also used to determine the effects of valvular heart disease. Most heart caths are performed from the left side, but right- sided heart caths are also regularly conducted to calculate cardiac output, measure right heart pressures, and identify pulmonary emboli. If your patient is really sick, they may get both. Radioisotope studies: Sometimes, the physician needs an even more detailed picture of what is going on in the heart...and this means you’ll be going on a road trip with your patient to Nuclear Medicine (also called “Nuc Med” by those in the know.) These are relatively non-invasive (except for the IV that’s required) and are generally well-tolerated by the patient. Like many tests, it does require that the patient hold still for extended periods of time, so if your patient has a lot of anxiety or is confused, this could be a problem! For this test, a small amount of radioactive material is injected and the emissions from this material are detected with the imaging device to show distribution of blood flow to the heart and details about cardiac function. And yes, it’s pretty cool to watch! Clot prevention: In some cases, your patient may simply need to take clot-prevention drugs such as warfarin (Coumadin), heparin or one of the newer anticoagulants such as Pradaxa or Xarelto. Each has benefits and risks, but the main difference between warfarin or heparin and the newer medications is that the newer ones don’t require regular blood monitoring. Before you go and get too excited, think about it...an anticoagulant medication that doesn’t require monitoring can be extremely risky. It is also important to understand that while warfarin and heparin both have antidotes, these newer drugs do not. UPDATE: There is now a reversal agent for Factor Xa Inhibitors called Andexanet alfa. It’s a good thing too. Google Eliquis or Xarelto along with the word “hemorrhage” and you’ll understand pretty quickly why these medications should not be taken lightly. Clot lysis: If you recall that “lysis” refers to breaking something apart, then you’ll realize this is Going on a road trip referring to the “clot busting” drugs, also refers to any time you have to take known as thrombolytics. The most commonly the patient out of the room for a used medications are activase and alteplase diagnostic test or procedure. (TPA). These drugs help to break up and dissolve clots that are occluding vessels. Critically ill patients in ICU require a nurse to be present at all times, so Angioplasty: This invasive procedure involves placing a if you work in intensive care, and balloon at the stenotic area to widen a your patient needs a CT scan, MRI narrowed or obstructed blood vessel. or Nuc Med study, guess what? You are going on a road trip! Endarterectomy: This is a surgical procedure to remove And yes, it is as scary as it plaque material or blockage in the lining sounds...but never fear, prepare of an artery...usually the carotid artery in the well and you’ll do great! neck. 2 CARDIOVASCULAR - MED/SURG 1 Stent: The placement of a stent holds an artery open. Patients who receive stents will have to take anticoagulant medication as clots like to form on foreign objects. Valve surgery: When the heart valves are faulty, they can be repaired or replaced. The types of surgeries refer to the valve in question. For example, an AVR is an aortic valve replace- ment while an MVR refers to the mitral valve. Valves are repaired or replaced when they are not operating optimally as in regurgitation or stenosis. More on these issues later. Bypass surgery: CABG (coronary artery bypass graft) and peripheral bypass are very serious surgical procedures. In a CABG (pronounced “cabbage”), arteries or veins from elsewhere in the body are grafted to the coronary arteries in order to bypass atherosclerotic narrowings and improve the blood supply to the heart. Peripheral arterial bypass refers to treating blockages in the vessels of the legs. Amputation: In cases of severe vascular disease, sometimes amputation is the only available treatment. Arterial & Venous Disorders It is important to understand that the cardiovascular system involves two types of blood vessels: arteries and veins. You absolutely must know the implications of an arterial disease vs. a venous disease as the signs/symptoms are different and so are the treatments. More details on this in a bit. Examples of arterial disorders: Atherosclerosis: Both coronary artery disease (CAD) and peripheral artery disease (PAD) involve thickening and hardening of arterial walls. When these vessel walls harden and become thick, blood flow is impaired, so you will see problems downstream of the artery.
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