NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*

MIDWIFERY*MEDTECH LET*PSYCHOMET*RESPIRATORY
THERAPY*CIVIL SERVICE*NAPOLCOM NCLEX*DHA*HAAD*
PROMETRIC* UK-CBT

HANDOUTS
MS: CARDIO AND RESPI
Prepared By: Archie Alviz, RN, RM, MAN, MN(o), NC II

Medical Surgical: Cardiovascular Disorder Handout

Layers of the heart

endocardium
Myocardium
Pericardium
Visceral pericardium
Parietal pericardium

Conduction System
[Link] node- the pacemaker
2. AV node- slowest conduction
3. Bundle of His – branches into the Right and the Left bundle branch
4. Purkinje fibers- fastest conduction

Properties of the heart

1. Automaticity – repetitive and spontaneous
2. Excitability - stimuli
3. Conductivity – transmit impulses
4. Contractility -
5. Refractoriness – inability to respond to a new stimulus while is still in
contraction

Diagnostics

Holter monitor
• 24 hours
• Aka Telemetry unit
• Nurse/client/SO – log/record activities and any unusual sensations
• Instruct the client to resume normal activities

2d echo
• Assess cardiac structure and mobility
• Painless
• 30 – 60 minutes
• No special preparation is needed

Threadmill testing

Purpose:
1. Identify ischemic heart disease
2. Evaluate chest pain
 NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*
MIDWIFERY*MEDTECH LET*PSYCHOMET*RESPIRATORY
THERAPY*CIVIL SERVICE*NAPOLCOM NCLEX*DHA*HAAD*
PROMETRIC* UK-CBT

3. Evaluate effectiveness of therapy

4. Fitness program during cardiac rehabilitation

Responsibilities

Staking tea, alcohol, coffee day before

Take comfortable shoes and clothing
Rest adequately the night before
Explain the need to report SOB and CP
Eat a light meal only 2 hrs before
Stop smoking

Pharmacological Management

Digoxin

Digibind (digoxin immune fab)

Instruct to measure pulse daily
Give foods high in K
Observe for signs of hypokalemia
X do not give if hr <60 bpm
Instruct to wof s/sx of toxicity
Note that elderly are more sensitive

Calcium Channel Blockers

Calcium level monitoring

Assess pulse and BP
Antidote is GLUCAGON
Liver enzyme level
Client should not crush or chew
Instruct to take drug before/2 hrs after meals
Usual kidney function test
MD if with dizziness and fainting

Beta Blockers

BP and HR monitoring
Bawal – ASTHMA
Look for respiratory distress
Orthostatic hypotension prevention
CHF detection
Keep taking – x rebound HPN
Eliminates OTC cold prep
Report dizziness, lightheadedness

Antiplatelet Aggregate
 NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*
MIDWIFERY*MEDTECH LET*PSYCHOMET*RESPIRATORY
THERAPY*CIVIL SERVICE*NAPOLCOM NCLEX*DHA*HAAD*
PROMETRIC* UK-CBT

Assess for s/sx of bleeding

Straining stool is a NO-NO!
Should be given with food
Aspirin toxicity

Anticoagulants

Heparin
Have Prothamine SO4 at hand
End after 2 weeks of therapy
PTT and APTT check
Assess for bleeding
Remind NOT to aspirate & massage
Injection via Sub-Q
Note for hematoma on the site of injection

Warfarin
WOF bleeding
Antidote is Vitamin K
Assess PT regularly
Reminder: ASA + Coumadin = severe bleeding
Reminder: GREEN LEAFY VEG X

Thrombolytics
Bleeding monitoring
Look for occult blood
Employ pressure on punctured sites
Explore for neuro changes
Determine HTN and tachycardia
Injection is avoided
Nice to use electric razor
Get ready for AMINOCAPROIC ACID

Cardiovascular Disorders

Angina
EXERTION
EMOTIONS
HEAVY MEALS
ENVIRONMENT

Pain: Relieved by rest

Quality: Aching stabbing
Radiation: Unilateral
Severity: Mild to moderate
Time: Less than 30 mins

Myocardial Infarction:
 NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*
MIDWIFERY*MEDTECH LET*PSYCHOMET*RESPIRATORY
THERAPY*CIVIL SERVICE*NAPOLCOM NCLEX*DHA*HAAD*
PROMETRIC* UK-CBT

embolus and thrombus

hemorrhage, shock
Hypercholesterolemia
Smoking
Obesity, Sedentary lifestyle
Stress

Pain: Not relieved by rest

Quality: Excruciating
Radiation: Bilateral
Severity: Severe
Time: More than 30 mins
ECG pattern: Pathologic Q wave

Rheumatic Heart Fever

Management:
DOC – penicillin (5-10 days)
- treatment continued up to 10 years
IF with allergy –erythromycin or clindamycin
Salicylates – for pain and swelling
Corticosteroids – relieves carditis

Heart Failure
Diagnostics:
[Link]: CARDIOMEGALY
2. 2D Echo: HYPOKINETIC HEART
3. Pulse Oximetry: DEC O2 SATURATION
4. PCWP: LSHF
5. CVP: RSHF

Management:
Fowlers
Administer high O2 (venturi)
Inotropic drugs (Dopamine)
Lanoxin
UO and intake monitoring
Record daily weight
Edminister diuretics and digoxin

Cardiac Tamponade

- Cardiac emergency
- Rapid accumulation of fluid in the pericardial sac
MANAGEMENT:
- Fowler’s
- Pericardiocentesis
 NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*
MIDWIFERY*MEDTECH LET*PSYCHOMET*RESPIRATORY
THERAPY*CIVIL SERVICE*NAPOLCOM NCLEX*DHA*HAAD*
PROMETRIC* UK-CBT

DISORDERS OF THE RESPIRATORY SYSTEM

1. SINUSITIS
 inflammation of one or more of the paranasal sinuses
 Etiology
- upper respiratory infection
- Smoking
- Allergic rhinitis
- tooth infection
- pneumonia
- structural defects of the nose
- underwater swimming

• Findings
– pain over affected areas especially when palpated or percussed
> maxillary – cheek, upper teeth
> frontal – above eyebrows
> ethmoid – in and around the eyes
> spehnoid – behind eyes, occiput, top of head
– purulent nasal drainage and congestion
– nasal obstruction
– fever
– malaise
– headache
– Halitosis

Management
✓ Rest
✓ Increase OFI
✓ avoid ASA
✓ Antibiotics – acute 7-10 days, chronic 21 days
✓ Codeine
✓ Decongestants
✓ antral irrigation (sinus irrigation) - warm NSS

Surgical management:
Caldwell-Luc procedure
- aka Radical Antrum Surgery
- Incision: b/t upper gum and lower lip
Ethmoidectomy
Sphenoidotomy
Ethmoidotomy

2. TONSILITIS
Definition: inflammation and infection of tonsils
Etiology: acute form is usually bacterial

Findings
 NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*
MIDWIFERY*MEDTECH LET*PSYCHOMET*RESPIRATORY
THERAPY*CIVIL SERVICE*NAPOLCOM NCLEX*DHA*HAAD*
PROMETRIC* UK-CBT

o sore throat - may be recurrent

o fever
o difficulty swallowing
o enlarged tonsils and adenoids
o foul smelling breath
o noisy respirations - snoring loudly during sleep if enlarged adenoids
o recurrent ear infections

Diagnostics - positive throat cultures for causative microbes

Management:
▪ Rest
▪ Increase OFI
▪ Warm saline gargle
▪ Analgesics, anti infectives
▪ TONSILLECTOMY/ADENOIDECTOMY
Done if recurrent tonsillitis – 5-6 times/year
GABHS
Pre-op – PT
Post-op – prone > semi-fowler’s
▪ Oral airway until swallowing reflex returns
*** frequent swallowing - hemorrhage
▪ Hematemesis
▪ tachycardia

TONSILLECTOMY/ADENOIDECTOMY
✓ Acetaminophen – pain
✓ Avoid ASA
✓ Diet: ice-cold fluids, bland diet
✓ Avoid – red or dark colored drinks and citrus juices
✓ Increase OFI 2-3L
✓ Inform that black/dark stool is expected

***AVOID
- Coughing, sneezing, blowing – 1-2 weeks
- Hard scratchy foods
- Cold, overcrowded public places

3. COPD/CAL

ETIOLOGIES:
- Chronic cigarette smoking
- Aging process
- Male > female
- Chronic respiratory infections
- Environmental pollutants
- EMPHYSEMA
- CHRONIC BRONCHITIS
 NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*
MIDWIFERY*MEDTECH LET*PSYCHOMET*RESPIRATORY
THERAPY*CIVIL SERVICE*NAPOLCOM NCLEX*DHA*HAAD*
PROMETRIC* UK-CBT

3A. CHRONIC BRONCHITIS

CRITERIA:
- Persistent productive cough
- Duration: 3 months in 2 consecutive years

Manifestations:
- “blue bloaters”
- Productive cough
- Wheezing
- SOB
- Prolonged expiration + blowing
- Clubbing
- Cyanosis
- Hypercapnia and hypoxia

3B. EMPHYSEMA
- Loss of elastic recoil > overdistended alveoli
- Air trapping > resp acidosis

Manifestations:
- “pink puffers”
- Pursed lip breathing
- DOB on exertion
- Speaks in short phrases
- Use of accessory muscles for breathing
- Barrel chest – widened AP
- clubbing

Management:
- Orthopneic position
- Increase OFI
- Diet – increase CHON, Vit. C
- O2 inhalation – 1-2 Lpm

COPD/CAL COLLABORATIVE MANAGEMENT:

1. Rest
2. Increase Ofi
3. Diet – increase CHON, calorie, dec CHO
4. O2 therapy – 1 -3 Lpm (ave 2 Lpm)
5. CPT
6. Steam inhalation
7. Expectorants
8. Antitussive – given at night
9. Bronchodilators
10. antimicrobials

4. ASTHMA
 NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*
MIDWIFERY*MEDTECH LET*PSYCHOMET*RESPIRATORY
THERAPY*CIVIL SERVICE*NAPOLCOM NCLEX*DHA*HAAD*
PROMETRIC* UK-CBT

✓ Hyperresponsiveness > bronchospasm

✓ Reversible

Common Allergens:
- pollens, molds, dust, weeds, pet danders, eggs, seafoods

Exacerbation:
- Air pollutants
- Cold-heat weather changes
- Stronf odors
- Excertion, exercise, laughing, GERD, sinusitis

Manifestation – Expiratory whEEzEs

Management:
- Bronchodilator