2.  Ms. Sophie is a 74 year old female who will be
admitted to your floor for complaint of shortness of
breath with activity and wound on left ankle. She
reports a regular diet of fast food, potato chips, and
chocolate. Loves salty food. She also states that she
often feels stressed and depressed because of her
weight however, she eats ice cream when she gets
stressed. She does not exercise and often feels very
tired. She has had two toes amputated from her left
foot and she complains that her feet “fall asleep”
easily. Patient states “feet look puffy.” She also has
“moments” of chest pain. She walks with a cane.

3. Smoker
High cholesterol
Diabetes
MI x 3 years
Cardiac stent
DNR
CHF
Angina
PVD
CAD
HTN
PTCA
Meds: Furosemide, Nitroglycerin,Captopril, Metoprolol

4.  Smoker - ↑BP, dysrhythmia, PVD
 High Cholesterol – occlusion of arteries
 Diabetes - ↑risk of MI & CVA (TIA)
 MI – ischemia, damage

5.  Cardiac stent – open occluded artery

CHF – Left sided Lungs
Right sided Rest of body
 Angina – chest pain associated with ↓coronary
artery blood flow
 PVD - ↑thrombus

6.  HTN – sex, aging, HX, overweight, inactivity
 Obesity - ↑demand, ↑adipose tissue
 Stress - ↑ cortisol
 Nutrition - ↑ salt

7.  Age
 Fall Risk
 Metabolic syndrome risk
 Activity level

8.  Blood pressure: 160/90
 RR 16
 Pulse 74
 Fingerstick: 450
 Height: 5’2”
 Weight: 180 lbs.
 Pedal pulses not palpable
 Lower extremity edema
 Left lower extremity edematous, red, warm
 BLE shiny, lack of hair, cool to touch
 Stage III wound on LLE ankle

9. PVD – mostly affects lower extremities
- Risk factors: age > 50, HX of heart
disease, Type I diabetes, HTN, obesity,
physical inactivity, smoking
- Symptoms: fragile skin on legs/feet,
hair loss on legs, non-healing wounds,
gangrene, complaint of “numbness”
- Diagnosis: angiogram
- Complications: Stroke, MI, amputation

10.  Most common type of heart disease
 Arteries to heart become hardened and narrow
 Plaque →↑cholesterol→atherosclerosis→
↓blood supply→angina or MI
 Over time = heart failure

11. MEDS: Furosemide,Heparin,Captopril,Metoprolol
EKG
Telemetry
Echocardiagram
Stress test
Ultrasound
Angiogram
TEDS/SCD’s right leg
Doppler LLE

12.  Furosemide
 Nitroglycerin
 Heparin
Insert drug table here
MEDICATION EXPECTED OUTCOME
Cardiac glycosides Increase cardiac contractility;
decrease heartrate
Antihypertensives Decrease blood pressure
Vasopressors Increase blood pressure
Antiarrhythmics Regulate heart rhythm
Nitrates Relieve angina
Antilipids Decrease cholesterol levels
Diuretics Reduce fluid volume
Anticoagulants Decrease potential for clot formation

13. 4th
ICS
&
5th
ICS

15. Normal Sinus Rhythm
P wave – atrial depolarization
Q,R,S complex- ventricular
depolarization
ST segment-complete depolarization
of ventricles
T wave- ventricular repolarization

17. PR interval = 0.12 – 0.20 seconds (or 3 small – 1
large box)
QRS complex = 0.06 – 0.12 seconds (or 1.5 – 3
small boxes)
QT interval = 0.34-0.43 seconds (or 8.5 – 11 small
boxes)
Heart rate = # of PQRST complexes that occur in 6
seconds multiplied by 10
Small square = 0.04 seconds
Large square = 0.20 seconds
Five small squares = a large
square
Five large squares = 1 second

18. Leads I, II, III, aVR, aVL & aVF are measurements of the
frontal plane
V1, V2, V3, V4, V5 & V6 are measurements of the horizontal
plane

19. RA LA
HEART
RL LL
-continuous
monitoring
 Clouds over grass
 Smoke over fire
 Chocolate is good
for your heart

20.  EKG
 Telemetry
 Assist with leg exercises, positioning, SCDs/TEDS
 Medication :Anticoagulation prophylaxis, diuretics, I & O
 Assessment
 Education

21. TEDS
(Thromboembo
lic Deterrent
Stockings)
SCD’s
(Sequential
Compression
Device)

22. o Test to see how blood moves
through arteries and veins
o Combines traditional
ultrasound with doppler
o No preparation needed

23. http://www.youtube.com/watch?v=yzxSrLa1d0g
o
Use of radiopaque dye to outline
vessels looking for blockage or
narrowing

24. http://www.youtube.com/watch?v=N7nghr9TpSU
o Percutaneous Transluminal Coronary
Angioplasty
o Catheter placed through IV in neck, arm or
groin
o Balloon tip inflated to compress blockage
o Possible stent placement

25.  Placed with balloon
catheter
 Locks in open position
 Monitor for
dysrythmias

26.  Check peripheral pulses & VS
 Assess pain
 Assess bleeding or hematoma formation at
insertion site
 Maintain pressure dressing & immobilize limb for
approximately 6 hours
 Monitor for urination within 6 hours
 Administer fluids
 Document

27. http://www.youtube.com/watch?v=x_Z0GF6AuTw
Records
cardiovascular
response to
increased activity

28. http://www.youtube.com/watch?v=2XR6etAY_-w&feature=related
-Ultrasonic waves
- Detect structural defects
-Can be done at bedside

29.  DNR – do not rescusitate
 DNI – do not intibate
 MOLST – Maryland Order for Life Sustaining
Treatment

30. 1. Smoking – most modifiable risk factor for
cardiovascular disease
2. Medication
3. Edema
4. Pain management
5. Activity intolerance
6. Diet

31.  Peripheral
intravascular device
 Inserted by
nurses/techs
 Short term

32. Triple Lumen Central Line
 Can be placed at bedside
 Placed into internal jugular
 Risk of pneumothorax or air
embolism
 Short term
Hickman
 Placed on OR
 Terminates in superior vena cava
near entrance to right atrium
 Tunnelling
 Long term

33. Peripherally Inserted Central
Catheter
 Terminates in subclavian
or superior vena cava
 Small diameter
 Long term

34. Mediport
 Placed in OR
 Terminates in superior
vena cava near entrance
to right atrium
 Self sealing port
 Long term
Huber needle
 Non-coring needle used
to access mediport

35. oFirst responder
oBedside nurse
oCharge nurse
oTeam/Code Leader
oRecorder
oRunner
oRespiratory/Anesthesia
oCode cart nurse
oNursing supervisor
oSecurity

36. Emergency meds
Defibrillator
Blood drawing supplies
Central line kit
Backboard

37.  Laryngoscope
 Oropharyngeal airway

38.  60-100 pbm

39. Bradycardia - <60 bpm
Tachycardia - >100 bpm

40.  Ectopic foci in walls of ventricles
 ↓ cardiac output
 Intrinsic ventricular rate is only 20-40 bpm

41.  Premature ventricular contraction
 Irritable focus in ventricle
 More likely to occur during bradycardia
 A beat, not a rhythm
 Cause
Bigeminy – PVC’s with every other beat
Trigeminy – PVC’s every third beat
Quadreminy – PVC’s with every fourth beat

42. • Foci in ventricles takes over
• When 3 or more PVC’s occur in a row at a rate
greater than 100 bpm lasting longer than 30
seconds
• Treatment: cardioversion & CPR. Long term-
antiarrythmic drugs

43.  Rapid, disorganized depolarization of ventricles
 No coordination of ventricular and atrial contractions
 No palpable pulse
 Treatment: Defibrillation & CPR. Long term: ICD

44.  Pulseless electrical activity
 Electrical activity is present but no
contraction
 No cardiac output, no tissue
perfusion, death

45.  No electrical activity
 Immediate loss of oxygen supply to brain, heart
and tissue

46. Holter monitor
o Worn for 1-3 days
o Records activity of
heart

47. Pacemaker
o Used to augment or replace
the natural pacemaker of
the heart
o Can be used for
bradycardia/tahcycardia,
damage to heart from MI,
CHF

49. ICD – Implantable Cardiac
Defibrillator
o To treat ventricular tachycardia
and ventricular fibrillation
o Patients say a shock is like being
kicked in the chest
o Another person touching the
person will feel the shock