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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
Cardiac/Vascular Circulation

Brenda Rowe, RN, MN, JD

Georgia Baptist College of Nursing

of Mercer University

c o stroke vol x heart rate
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
cardiac effects of digoxin
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
digoxin

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

nursing interventions
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
other cardiac glycosides
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
critical thinking exercise
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?
nitroglycerin
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
tolerance adverse effects
Tolerance & Adverse Effects
  • Tolerance may develop
  • Less likely in sublingual & translingual spray
  • Most common adverse effects: headache, can have hypotension, tachycardia, syncope
anginal episode
Anginal Episode
  • Have a person lie down
  • Give nitroglycerin tabs x 3, if needed, 5 minutes apart
  • If no relief – call 911
education
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
education cont
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
antiarrhythmics

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)

antiarrhythmic agents

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

lidocaine
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
antiarrhythmic agents cont

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

amiodarone cordarone
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
verapamil hcl calan
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
potassium removing resins
Potassium-Removing Resins
  • Sodium polystyrene sulfonate (Kayexalate)
  • oral or enema
  • AE - hypokalemia
antihyperlipidemics
Antihyperlipidemics
  • Definition
  • HDL/LDL
statins
Statins
  • lovastatin (Mevacor)
  • Blocks synthesis of cholesterol in liver
  • Decrease LDL, increase HDL
bile acid sequestrants
Bile acid sequestrants
  • cholestyramine (Questran)
  • Lower LDL levels
  • Binds bile acids in intestine
new drugs
New drugs
  • How actions differ
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