What does ALS stand for?
Advanced Life Support
What is the initial nursing care assessment of a pt with HF?
- subjective and objective health hx
- sleep and activity
- Physical Exam
- mental status
- Respiratory assessment = lung sounds
- cardiovascular assessment = heart sounds
- Fluid status/signs of fluid overload = daily weight/input and output
- assess response to medications
- further medical investigations = CXR, ECG, bloods
What is the initial assessment for a pt presenting with acute CP or ACS symptoms?
Always assume cardiac till proven otherwise.
- 12 lead ECG recorded and assessed within 10 minutes of presentation
- receive caare based on the ACS assessment protocol
- cardiac specific troponin =bloods
- Aspirin (300mg stat unless contraindicated)
- Oxygen therapy = only if below 93%
What are the 2 shockable rhythms?
- Ventricular fibrillation
- ventricular tachycardiac
In ALS what do the 4H’s stand for when assessing reversible causes?
- hypoxaemia
- hypovolaemia
- hyper/hypokalaemia
- hypo/hyperthermia
In ALS what do the 4T’s stand for when assessing reversible causes?
- tension pneumothorax
- tamponade
- toxins (poisons/drugs)
- thromboembolic (coronary/pulmonary)
the 2 most prevalent and fatal disease affecting the heart are?
- coronary heart disease
- heart failure
What does it mean if the ECG features a ST-segment elevation with tall T wave?
Myocardial infarction
what is the nursing management of ACS or MI pt’s?
- need to reduce myocardial workload and maximise cardiac output
- provision of treatment
- careful monitoring to determine the effects of treatment and to detect complications
- comfort and pain control
- psychological support and education
- discharge planning
cardiac rehabilitation is structured around 4 phases, with phase 1 beginning during admission. These include?
- info regarding disease process
- assessing the pt on understanding
- discharge planning
- early mobilisation
what is pericarditis?
inflammation of the visceral and parietal layers of the pericardium that covers the heart.
Management of HF post the acute phase is based on 3 principles. What are these?
- self-care management
- long-term lifestyle changes
- adherence to pharmacotherapy
Pt assessment for HF involves?
- ECG
- CXR = will show cardiomegaly and pulmonary problems
- physical assessment
- cardiovascular assessment = pulse rate, rhythm and strength; IPPA; BP lying and standing, checking peripherals
- pulmonary assessment- chest ausculatation for inspiratory crepitations that do not clear with cough
- FBC - checking for anaemia and thrombocytopenia
- Urea
- Urinalysis
What is heart failure?
The inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients
How is heart failure catergoried?
Fluid overload and inadequate tissue perfusion
What are some of the symptoms of heart failure?
- fatigue
- weakness
- oedema
- nausea
- polyuria
- cough/wheeze
- orthopnoea
- ascites
What are the nursing interventions of a pt with HF?
- promoting activity tolerance= encourage mobility, spreading out activities, cardiac rehab programs
- monitoring fluid volume= daily weighing, fluid restrictions, FBC, nutrition modifications (low sodium diet)
- oxygen therapy
- psychological support = decreasing stress
A blood transfusion procedure consists of?
- collecting equipment
- performing pre-transfusion checks
- IV access
- performing all obs, prior, during and after
- documentation
Should a reaction occur what should you do?
- immediately stop the transfusion and clamp the line
- call Dr
- monitor the pt’s condition
- recheck pt’s ID with blood pack
- keep the blood and the line so it can be tested
- documentation
List the possible adverse reactions that could occur during a blood transfusion
- shivering
- flushing
- pain
- SOB
- decreased BP
- anaphylaxis
- rash/urticaria
- haemaglobinuria
List some ischaemic cardiovascular causes
- Tachy-arrhythmia
- stable angina
- severe aortic stenosis
- ACS
List some non-ischaemic cardiovascular causes
- PE
- GI causes
- pericarditis/myocarditis
- aortic dissection
List some medical management for HF
- prevent exacerbation
- reduce workload of the heart by reducing preload and afterload
- reduce or eliminate contributing factors
List the initial nursing interventions for a patient with ACS symptoms
- ECG
- Full blood test = checking cardiac troponin
- O2 therapy if stats are below 93% or 88-92% for COPD pt
- administration of Aspirin (300 mg) unless contraindicated
