Pericarditis inflammation of the pericardial tissue surrounding the heart

Pericarditis inflammation of the pericardial tissue

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Pericarditis - inflammation of the pericardial tissue surrounding the heart; usually occurs within 2–3 days of the event Dressler syndrome symptom complex characterized by fever, chest pain, and dyspnea. It may spontaneously resolve or recur over several months. (Fran Drescher w/high voice has chest pain, SOB & running fever) If a large vessel is occluded, the first sign of MI may be sudden death. Manifestations of AMI (Compensatory mechanisms cause many other symptoms of MI) Substernal or precordial chest pain that may radiate to the neck, jaw, shoulder(s), or left arm Tachycardia and tachypnea Dyspnea and shortness of breath N/V (GI tract is not getting enough oxygen) Anxiety Diaphoresis Cool skin; diminished peripheral pulses Hypotension or hypertension Palpitations and dysrhythmias Decreased LOC Signs of left-sided heart failure Intra-Aortic Balloon Pump (IABP) - filled with Helium - a device used to support cardiac function; ultimate in afterload reduction ; augments coronary and renal artery blood flow with inflation; preoperatively to optimize CO with cardiogenic shock or postoperative CAB. Balloon must always stay in motion, even if it is just fluttering because it is thrombogenic. Timed by RNs to augment/inflate on a 1:1, 1:2 or 1:3 ratio to ventricular diastole (blood goes to carotid artery to oxygenate the heart). Inflation timed to ECG’s QRS complex because it occurs before the mechanical arterial response; inflation occurring during systole occludes CO. Bed rest needed due to femoral access. Peripheral tissue perfusion is a priority (PVD accompanies CAD). Ethical dilemma life vs. limb - if rigor (no movement in foot) to lower extremity has developed, IABP must be removed in OR ready for emergent amputation. Disadvantage: it is thrombogenic. It must always remain in motion. Do not turn it off until it is time to remove it. At risk for losing your leg because circulation to the lower extremities is poor, especially the leg where the balloon pump is inserted. IABP explanation - start video at 30:35 Interventions : you will need a doppler, because you have to monitor pedal pulses (posterior tibial & dorsalis pedis). Major contraindications for heart transplant:
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smoking cessation <6 months substance dependency irreversible pulmonary hypertension psychosocial issues/behavioral health assessment inadequate decision making capacity other end-organ issues Ventricular Assist Device (VAD) Can partially or completely function for the impaired ventricle(s) Right VAD, Left VAD, BiVAD to support both sides Chest closure is optional but patient cannot be ambulatory when open Some models are suited for longer-term ambulatory bridging to transplant Medicare & Medicaid’s criteria for receiving LVADs NY Heart Association class IV (severe limitations) IABP in place for >7 days and can’t wean off No response to medical therapy EF < 25% Adequate right ventricular function ECMO: she will not ask about this. It removes volume, oxygenates it, and returns it. It also increases afterload and myocardial oxygen demand, slightly.
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  • Fall '09
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