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Cardiac/Vascular Circulation

Cardiac/Vascular Circulation Brenda Rowe, RN, MN, JD Georgia Baptist College of Nursing of Mercer University C.O. = Stroke Vol. X Heart Rate Preload - passive stretching force exerted on ventricle muscle Contractility - force of the squeezing that the ventricle is able to achieve

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Cardiac/Vascular Circulation

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  1. Cardiac/Vascular Circulation Brenda Rowe, RN, MN, JD Georgia Baptist College of Nursing of Mercer University

  2. C.O. = Stroke Vol. X Heart Rate • Preload - passive stretching force exerted on ventricle muscle • Contractility - force of the squeezing that the ventricle is able to achieve • Afterload - amount of pressure the ventricle muscle must overcome to eject • Contraction - dependent upon conduction system

  3. Cardiac Effects of Digoxin • Positive inotropin effect: strengthens the force of contraction • Negative dromotropin effect: decreases conduction • Negative chronotropin effect: decreases heart rate • Improve renal perfusion

  4. Digoxin * CHF, atrial fib * digitalization * toxic effects - N&V, diarrhea, green/yellow vision, double vision, headache, dizziness, fatigue, weakness * monitor effectiveness * watch for hypokalemia * education * antidote - digoxin immune FAB

  5. Nursing Interventions • Monitor HR - apical for 1 minute • Monitor Dig level - 0.5-2.0 ng/ml • Monitor K, Calcium, Mag - increase in calcium or decrease in K or Mag will potentiate the effect of Digoxin

  6. Other Cardiac Glycosides • inamrinone (Inocor) & milrinone (Primacor): increase force of contraction and produce a vasodilatory effect which increases cardiac output • Used for short term management of CHF

  7. Critical Thinking Exercise • A patient with CHF • Is on Digoxin, Lasix, and potassium supplement • What is the desired therapeutic effect? • Why should hypokalemia be prevented? • What blood work should be monitored?

  8. Nitroglycerin • Relaxes vascular smooth muscles & dilates arterial & venous vessels thus reducing afterload & myocardial consumption • Acute angina: sublingual, transmucosal, or translingual spray • Prophylactic for angina: above & topical & oral SR • IV: used to treat primarily hypertension

  9. Tolerance & Adverse Effects • Tolerance may develop • Less likely in sublingual & translingual spray • Most common adverse effects: headache, can have hypotension, tachycardia, syncope

  10. Anginal Episode • Have a person lie down • Give nitroglycerin tabs x 3, if needed, 5 minutes apart • If no relief – call 911

  11. Education • Smoking causes vasoconstriction which may cause angina • Sublingual: keep in original bottle with tight cap • Transdermal: nonhairy area but avoid distal parts of extremities, remove patch for 10-12 hours

  12. Education (cont.) • Increase absorption with broken skin, increase with exercise, increase temperature (avoid sauna) • Ointment: choose a different application site, use tissue to remove any old ointment, do not massage or rub in ointment

  13. Antiarrhythmics * see after MI, cardiac surgery, CAD, electrolyte imbalance, thyroid disease * abnormality with initiation of impulse or in impulse conduction or both * should be monitored, most meds given IV, monitor AP (rate & rhythm)

  14. Antiarrhythmic Agents Quinidine (Cardioquin) – class 1A depresses Phase 0 in depolarization * depresses cardiac function, however inhibits vagal action so may have sinus tachycardia * has high incidence of adverse effects with most common being GI * monitor renal & liver function

  15. Lidocaine • Lidocaine (Xylocaine) - Class 1B depresses phase 0 but not as much as Quinidine • brief action so less chance of cumulative drug toxicity, make sure you have correct type of Lidocaine, tx ventricular arrhythmias • give IV

  16. Antiarrhythmic Agents (cont.) Flecainide (Tambocor) - Class 1C markedly depresses phase 0, tx PAF or flutter & ventricular arrhymias, suppress conduction, many adverse effects Propranolol (Inderal) - Class II depresses phase 4 depolarization, beta adrenergic blocking agent, tx arrhythmias secondary to dig toxicity, also used to tx hypertension, angina & MI

  17. amiodarone (Cordarone) • Amiodarone (Cordarone) - Class III prolongs phase III repolarization • increases refractory period, increases myocardial contractility, vasodilatory action • used to prophylaxis and therapy of vent fib • keep pt supine - most common AE is orthostatic hypotension

  18. Verapamil HCL (Calan) • Class IV depresses phase 4 depolarization & lengthens phase 1 & 2 of repolarization • calcium channel blocker, decrease myocardial contraction, decrease SA node impulse, decrease conduction, also causes CA dilatation & peripheral vasodilatation • also used to tx angina • watch for bradycardia & hypotension • AE - most common is constipation • IV solution must be protected from light • Administer slowly – greater than 2 minutes

  19. Potassium-Removing Resins • Sodium polystyrene sulfonate (Kayexalate) • oral or enema • AE - hypokalemia

  20. Antihyperlipidemics • Definition • HDL/LDL

  21. Statins • lovastatin (Mevacor) • Blocks synthesis of cholesterol in liver • Decrease LDL, increase HDL

  22. Bile acid sequestrants • cholestyramine (Questran) • Lower LDL levels • Binds bile acids in intestine

  23. New drugs • How actions differ

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