CARDIAC ANATOMY AND PHYSIOLOGY The heart = located in the left side of the mediastinum. Layers: a.

The epicardium (outer layer of the heart) b. The myocardium (middle layer, actual contracting muscle of the heart.) c. The endocardium (inner layer and lines the inner chambers and heart valves) Pericardial sac Encases and protects the heart from trauma and infection Layers: a. The parietal pericardium - outer membrane Attaches : anteriorly to the lower half of the sternum, posteriorly to the thoracic vertebrae, inferiorly to the diaphragm. b. The visceral pericardium is the thin, inner layer that closely adheres to the heart. pericardial space between the parietal and visceral layers; holds 5 to 20 mL of pericardial fluid, lubricates the pericardial surfaces, and cushions the heart. Coronary arteries 1. The coronary arteries supply the capillaries of the myocardium with blood. 2. The right coronary artery supplies: right atrium and ventricle inferior portion of the left ventricle, posterior septal wall, sinoatrial and atrioventricular nodes. 3. The left main coronary artery consists of two major branches: left anterior descending Circumflex arteries. 4. The left anterior descending artery supplies: anterior wall of the left ventricle anterior ventricular septum, apex of the left ventricle. 5. The circumflex artery supplies blood : left atrium lateral and posterior of the left ventricle. The vascular system 1. Arteries are vessels through which the blood passes away from the heart to various parts of the body; they convey highly oxygenated blood from the left side of heart to the tissues. 2. Arterioles control the blood flow into the capillaries. 3. Capillaries allow the exchange of fluid and nutrients between the blood and the interstitial spaces. 4. Venules receive blood from the capillary bed and move blood into the veins. 5. Veins transport deoxygenated blood from the tissues back to the right heart and then to the lungs for oxygenation. 6. Valves help return blood to the heart against the force of gravity. 7. The lymphatics drain the tissues and return the tissue fluid to the blood. Cardiac conduction system:

Sinoatrial (SA) node 1. The main pacemaker that initiates each heartbeat 2. It is located at the junction of the superior vena cava and the right atrium. Atrioventricular (AV) node 1. Located in the lower aspect of the atrial septum 2. Receives electrical impulses from the sinoatrial node The bundle of His 1. A continuation of the AV node; located at the interventricular septum 2. The right and left bundle branches terminate into Purkinje fibers. Purkinje fibers 1. Purkinje fibers are a diffuse network of conducting strands located beneath the ventricular endocardium. 2. These fibers spread the wave of depolarization through the Ventricles. Factors affecting effectiveness and function of pump: 1. Cardiac output: 2. Neural control: 3. Chemical control: 4. Mechanical control: 5. Bp control: Common assessment area: Heart sounds 1. (S1)- atrioventricular valves closure - heard loudest at the apex of the heart. 2. (S2)-semilunar valves closure - heard loudest at the base of the heart. Abnormal heart sounds: 3. (S3) - ventricular gallop -decreased ventricular wall compliance -ventricular wall structure vibration congestive heart failure valvular regurgitation. - may be normal in younger than 30 years. 4. (S4)- atrial gallop may be heard on atrial systole if present. cardiac hypertrophy, injury to the ventricular wall. Heart rate 1. The faster the heart rate, the less time the heart has for filling, and the cardiac output decreases. 2. An increase in heart rate increases oxygen consumption. normal sinus heart rate is 60 to 100 beats/min. Sinus tachycardia is a rate more than 100 beats/min. Sinus bradycardia is a rate less than 60 beats/min. Risk Factors for Heart Disease Nonmodifiable: Positive family history for premature coronary artery disease resistance to ventricular filling is

Increasing age Gender (men and postmenopausal women) Race (higher incidence in African Americans than in Caucasians) Modifiable Hyperlipidemia Hypertension Cigarette smoking Elevated blood glucose level (dm) Obesity Physical inactivity Type A personality characteristics, particularly hostility Use of oral contraceptives Diagnostic test and procedures Nonivasive: Pulse oximetry registers the oxygen saturation of the client's hemoglobin. The normal value is 96% to 100%. can alert the nurse to hypoxemia before clinical signs occur. Procedure: a. A sensor is placed on finger, toe, nose, ear lobe, or forehead to measure oxygen saturation b. Maintain the transducer at heart level. c. Do not select an extremity with an impediment to blood flow. d. Results lower than 91% necessitate immediate treatment. DOPPLER DEVICE Doppler device detects movement of red blood cells through an artery; therefore, it eliminates environmental noise interference and produces audible sound. It is used to determine adequacy of blood flow when peripheral pulses cannot be palpated due to obesity, presence of occlusive vascular disease, cardiopulmonary collapse with vasoconstriction, postoperatively when peripheral blood flow may be compromised. Echocardiogram, Often referred to in the medical community as a cardiac ECHO or simply an ECHO, is a sonogram of the heart. Also known as a cardiac ultrasound, it uses standard ultrasound techniques to image twodimensional slices of the heart. The latest ultrasound systems now employ 3D real-time imaging. Exercise testing (stress test) a. test the heart during activity and detects and evaluates coronary artery disease. b. Uses a treadmill c. Maybe used with myocardial radionuclide testing d. If the client is unable to tolerate exercise, an (IV) infusion of dipyridamole (Persantine), dobutamine hydrochloride, or adenosine (Adenocard) is given to dilate the coronary arteries and simulate the effect of exercise. e. An informed consent is required if a radionuclide is injected. Preprocedure interventions a. informed consent b. rest the night before the procedure. c. light meal 1 to 2 hours before the procedure.

d. avoid smoking, alcohol, and caffeine before the procedure. e. Instruct the client to ask the physician about taking prescribed medication on the day of the procedure Intra: wear nonconstrictive clothing, supportive rubber-soled shoes Instruct the client to notify the physician if any chest pain, dizziness, or shortness of breath occurs during the procedure. Post: Instruct the client to avoid taking a hot bath or shower for at least 1 to 2 hours. ECG Basics of Electrocardiography small square -0.04 second. Large square -0.20 second. Horizontal line- time vertical line- voltage P- R interval: 0.12 0.20 sec QRS complex: 0.06 0.12 sec QT interval: 0.32 0.44 sec Invasive: Cardiac enzymes 1. CK-MB (creatine kinase, myocardial muscle) a. Elevation - myocardial damage. b. Elevation occurs within 4 to 6 hours Peaks 18 to 24 hours following an acute ischemic attack. c. Normal value is 0% to 5% of total; total CK is 26 to 174 units/L. Lactate dehydrogenase (LDH) a. Elevations -24 hours following M.I. Peak in 48 to 72 hours. b. Normally, LDH1 is lower than LDH2 c. The normal value of LDH in conventional units is 140 to 280 international units/L. Troponin a. troponin C cardiac troponin I = 0.6 ng/mL cardiac troponin T = 0 to 0.2 ng/mL b. Troponin I rises within 3 hours persists for up to 7 days. Myoglobin a. Myoglobin is an oxygen-binding protein found in cardiac and skeletal muscle. b. rises within 1 hour after cell death, peaks in 4 to 6 hours, returns to normal within 24 to 36 hours (even faster in some clients). Serum lipids serum cholesterol

lower than 200 mg/dL, low-density lipoprotein cholesterol lower than 130 mg/dL and high-density lipoprotein cholesterol 30 to 70 mg/dL. ABG CARDIAC CATHETERIZATION and ANGIOGRAPHY 1. The most invasive diagnostic procedure to determine cardiac defects 2. Provides information about oxygenation saturation of blood in great vessels and heart chambers 3. May be done for diagnostic, interventional, or electrophysiological reasons 4. May be carried out on an outpatient basis 5. Risks include hemorrhage from the entry site, clot formation and subsequent blockage distally, transient dysrhythmias Disorders: Cardiac dysrhymias Interventions a. Administer oxygen. b. Administer anticoagulants as prescribed c. Administer cardiac medications as prescribed to control the ventricular rhythm and assist in the maintenance of cardiac output. d. cardioversion as prescribed. Interventions a. Evaluate oxygen saturation to assess for hypoxemia, which can cause PVCs. d. Administer oxygen as prescribed. e. Evaluate electrolytes, particularly the potassium level (hypokalemia) f. Lidocaine may be prescribed. g. Notify the physician if the client complains of: chest pain PVCs increase in frequency, multifocal, occur on the T wave (R on T), progress to a more lethal dysrhythmias Stable client with sustained VT with pulse no signs or symptoms of decreased C.O. a. oxygen as prescribed. b. Antidysrhythmics: amiodarone (Cordarone), Lidocaine (Xylocaine), procainamide (Pronestyl) Unstable client with VT with pulse signs and symptoms of decreased C.O. a. oxygen and antidysrhythmic b. synchronized cardioversion c. Attempt cough (CPR) asking the client to cough hard every 1 to 3 seconds.

Pulseless ventricular tachycardia: Pulseless decrease C.O. Intervention: Defibrillation and CPR Ventricular fibrillation VF is a chaotic rapid rhythm in which the ventricles quiver and there is no cardiac output. VF is fatal if not successfully terminated within 3 to 5 minutes. Client lacks a pulse, BP, respirations, and heart sounds. Management: defibrillation MANAGEMENT OF DYSRHYTHMIAS Vagal maneuvers Carotid sinus massage Cough cpr Defibrillation a. Defibrillation is an asynchronous countershock used to terminate pulseless ventricular tachycardia (VT) or VF. During the procedure 1. Stop the oxygen 2. Dry surface 3. clear 4. Use of paddle electrodes Apply conductive pads. One paddle- third ICS R SB; One paddle- fifth ICS L MAL firm pressure of at least 25 lb to 5. 200 -> 300 -> 360 > cpr 1 min., give medication > 360 > 360 > 360 Cardioversion Synchronized Elective procedure -supraventricular tachydysrhythmias, unstable VT, stable tachydysrhythmias A lower amount of energy is used than with defibrillation. The defibrillator is synchronized to the client's R wave to avoid discharging the shock during the vulnerable period (T wave). MONOPHASIC Defibrillation is 360 J Cardioversion atrial rhythms is 50-100-200-300-360 v-tach is 100-200-300360 J BIPHASIC (use device-specific energies when known) Defibrillation is 200 J Cardioversion atrial rhythms is 30-50-75-120 J v-tach is 75-120-150-200 J

PACEMAKERS Temporary or permanent device that provides electrical stimulation and maintains the heart rate when the client's intrinsic pacemaker fails to provide a perfusing Rhythm Settings 1. A synchronous (demand) pacemaker senses the client's rhythm and paces only if the client's intrinsic rate falls below the set pacemaker rate to stimulate depolarization. 2. An asynchronous (fixed rate) pacemaker paces at a preset rate regardless of the client's intrinsic rhythm and is used when the client is asystolic or profoundly bradycardic. 3. Overdrive pacing suppresses the underlying rhythm in tachydysrhythmias Reducing the risk of microshock a. Use only inspected and approved equipment. b. Insulate the exposed portion of wires with plastic or rubber material (fingers of rubber gloves) when wires are not attached to the pulse generator; cover with nonconductive tape. c. Ground all electrical equipment using a three-pronged plug. d. Wear gloves when handling exposed wires. e. Keep dressings dry. Pacemakers: Client Education Instruct the client about the pacemaker, including the programmed rate. Instruct the client in the signs of battery failure Instruct the client to report signs of infection Wear a Medic-Alert bracelet and ID Instruct the client in how to take the pulse, to take the pulse daily, and to maintain a diary of pulse rates. Wear loose-fitting clothing over the pulse generator site. Avoid contact sports. Inform all health care providers that a pacemaker has been inserted. Avoid EM fields Instruct the client that if any unusual feelings occur when near any electrical devices to move 5 to 10 feet away and check the pulse. Use cell phones on the side opposite the pacemaker. ANTIdysRHYTHMIC MEDICATIONS Class I antidysrhythmics sodium channel blockers class II are b-blockers class III are potassium channel blockers medications that delay repolarization) class IV are calcium channel blockers. Other antidysrhythmics 1. Adenosine (Adenocard) 2. Digoxin (Lanoxin) Class IA antidysrhythmics 1. Disopyramide (Norpace) 2. Procainamide (Procanbid) 3. Quinidine sulfate Decrease diastolic depolarization Class IB antidysrhythmics 1. Lidocaine (Xylocaine) 2. Mexiletine hydrochloride (Mexitil) 3. Phenytoin (Dilantin) Class IC antidysrhythmics 1. Flecainide acetate (Tambocor)

2. Propafenone hydrochloride (Rythmol) 3. Moricizine (Ethmozine) 4. Side effects a. Hypotension b. Heart failure c. Worsened or new dysrhythmias d. Nausea, vomiting, or diarrhea Downer or DRY Considerations: For life threatening ventricular arrhythmia (PSVT) If with weight loss, or < 110 or 120 lbs, reduce dose Less sleep/ interruption- corrected by good scheduling. Use alarm clock for dose taking Norpace- note orientaion (psychosis,confusion) Procainamide- note bilateral grip strength Quinidine- avoid grape fuit, can cause mouth dryness (use chewing gum/ lozenges), diarrhea(use yogurt/ boiled milk) F. Class II antidysrhythmics Acebutolol (Sectral) 2. Esmolol (Brevibloc) 3. Propranolol (Inderal) 4. Side effects a. Dizziness b. Fatigue c. Hypotension d. Bradycardia e. Heart failure f. Dysrhythmias g. Heart block h. Bronchospasms- give theophylline i. Gastrointestinal distress j. Hypoglycemia (DKA, metab acidosis) k. Intermittent claudication avoid with raynauds Considerations: Avoid A adrenergic stimulant, cold preparation, nasal degongestant. Inderal- blocks B2 receptor (lungs)- cause bronchospasm. Decrease ICP by decreasing cerebral vasodilation Give a.c. Or H.s With meals better absorption If miss 1 dose- take as soon as remembered or at least 8 hours from next dose. Class III antidysrhythmics 1. Amiodarone (Cordarone, Pacerone) 2. Bretylium 3. Dofetilide (Tikosyn) 4. Ibutilide (Corvert) 5. Sotalol (Betapace) Side effects a. Hypotension

b. Bradycardia c. Nausea, vomiting d. Amiodarone hydrochloride may cause pulmonary fibrosis, photosensitivity- bluish skin discoloration corneal deposits peripheral neuropathy tremor, poor coordination, abnormal gait, papilledema hypothyroidism. e. Bretylium may cause vertigo, syncope, and dizziness Class IV antidysrhythmics 1. Verapamil (Isoptin SR, Calan, Verelan) 2. Diltiazem (Cardizem) 3. Side effects a. Dizziness b. Hypotension- give vasopressor c. Bradycardia / AV block- give atropine d. Edema e. Constipation f. Gingival hyperplasia Interventions for antidysrhythmics 1. Monitor heart rate, respiratory rate, and BP. 2. Monitor electrocardiogram. 3. Provide continuous cardiac monitoring. 4. Maintain therapeutic serum drug levels. 5. Before administering lidocaine, always check the vial label to prevent administering a form that contains epinephrine or preservatives because these solutions are used for local anesthesia only. 6. Do not administer antidysrhythmics with food because food may affect absorption. admin with food if with G.I. Upset in 2 divided doses. 7. Mexiletine may be administered with food or antacids to reduce gastrointestinal distress. 8. Always administer IV antidysrhythmics via an infusion pump. 9. Monitor for signs of fluid retention such as weight gain, peripheral edema, or shortness of breath. 10. Advise the client to limit fluid and salt intake to minimize fluid retention. 11. Monitor respiratory, thyroid, and neurological functions. 12. After administering bretylium, keep the client supine and monitor for hypotension. 13. Instruct the client to change positions slowly to minimize orthostatic hypotension. 14. Instruct the client taking amiodarone to use sunscreen and protective clothing to prevent photosensitivity reactions. - A/E = more prevalent with high doses, apparent in 6 months time. -A/E = totally reversible if meds is stopped. =resolution occurs in 3-6 months time. 15. Encourage the client to increase fiber intake to prevent constipation. 16. SR- small wax cores pass in stools ANGINA chest pain resulting from myocardial ischemia caused by inadequate myocardial blood and oxygen supply and demand Patterns of angina 1. Stable angina / exertional angina Occurs with activities that involve exertion or emotional stress

relieved with rest or nitroglycerin Usually has a stable pattern of onset, duration, severity, and relieving factors 2. Unstable angina / preinfarction angina Occurs with an unpredictable degree of exertion or emotion and increases in occurrence, duration, and severity over time Pain may not be relieved with nitroglycerin. 3. Variant angina / Prinzmetal's / vasospastic angina Results from coronary artery spasm May occur at rest Attacks may be associated with ST segment elevation 4. Intractable angina is a chronic, incapacitating angina unresponsive to interventions. 5. Preinfarction angina a. Associated with acute coronary insufficiency b. Lasts longer than 15 minutes c. Symptom of worsening cardiac ischemia d. Occurs after an MI, when residual ischemia may cause episodes of angina Assessment Pain a. develop slowly or quickly. b. described as mild or moderate. c. Substernal, crushing, squeezing pain may occur. d. radiate to the shoulders, arms, jaw, neck, or back. e. unaffected by inspiration and expiration. f. lasts less than 5 minutes; however, pain can last up to 15 to 20 minutes. g. Pain is relieved by nitroglycerin or rest. 2. Dyspnea 3. Pallor 4. Sweating 5. Palpitations and tachycardia 6. Dizziness and faintness 7. Hypertension 8. Digestive disturbances Diagnostic studies 1. ECG: Normal during rest, ST depression and/or T wave inversion during an episode of pain. 2. Stress testing: Chest pain indicate ischemia. 3. Cardiac enzyme and troponin levels: Findings are normal in angina. Interventions Administer oxygen at 3 L/min by nasal cannula as prescribed. Administer NTG as prescribed to dilate the coronary arteries, reduce the oxygen requirements of the myocardium, and relieve the chest pain. Obtain a 12-lead ECG. Provide continuous cardiac monitoring. progressive activity Side effects

Headache, Dizziness, weakness, Faintness, Confusion Nausea, vomiting Orthostatic hypotension Flushing or pallor, Rash Dry mouth, reflex tachycardia Transdermal patch Instruct the client to apply the patch to a hairless area in chest Apply- 12 hours Patch free - 12 hours MYOCARDIAL INFARCTION 1. occurs when myocardial tissue is abruptly and severely deprived of oxygen. 2. Ischemia can lead to necrosis of myocardial tissue if blood flow is not restored. 3. Infarction does not occur instantly but evolves over several hours. 4. Obvious physical changes do not occur in the heart until 6 hours after the infarction, when the infarcted area appears blue and swollen. 5. After 48 hours, the infarct turns gray, with yellow streaks developing as neutrophils invade the tissue. 6. By 8 to 10 days after infarction, granulation tissue forms. 7. Over 2 to 3 months, the necrotic area develops into a scar; scar tissue permanently changes the size and shape of the entire left ventricle. 8. Not all clients experience the classic symptoms of an MI. 9. Women may experience atypical discomfort, shortness of breath, or fatigue. 10. An older client may experience shortness of breath, pulmonary edema, dizziness, altered mental status, or a dysrhythmia. Diagnostic studies 1. Troponin level a. Level rises within 3 hours. b. Level remains elevated for up to 7 days. 2. Total creatine kinase level a. Level rises within 4 hours after the onset of chest pain. b. Level peaks within 24 hours after damage and death of cardiac tissue. 3. CK-MB isoenzyme a. Peak elevation occurs 18 to 24 hours after the onset of chest pain. b. Level returns to normal 48 to 72 hours later. 4. Myoglobin: Level rises within 1 hour after cell death, peaks in 4 to 6 hours, and returns to normal within 24 to 36 hours or less. 5. LDH level a. Level rises 24 hours after MI. b. Level peaks between 48 and 72 hours and falls to normal in 7 days. c. Serum level of LDH1 isoenzyme rises higher than serum level of LDH2. 6. White blood cell count: 10,000 to 20,000 /mm3 appears on the second day following the MI and lasts up to 1 week. Electrocardiogram shows ST segment elevation, T wave inversion, abnormal Q wave in leads facing the infarct.

Hours to days after the MI, ST and T wave changes will return to normal but the Q wave changes usually remains permanently. Assessment Pain a. Client may experience crushing substernal pain. b. Pain may radiate to the jaw, back, and left arm. c. Pain may occur without cause, primarily early in the morning. d. Pain is unrelieved by rest or nitroglycerin and is relieved only by opioids. e. Pain lasts 30 minutes or longer. 2. Nausea and vomiting 3. Diaphoresis 4. Dyspnea 5. Dysrhythmias 6. Feelings of fear and anxiety 7. Pallor, cyanosis, coolness of extremities Promote Sexual Education Resumption of Activity: 4 to 6 Weeks After Preparedness: Able to Climb Stairs without Dyspnea Best Time : Morning Medications : Take Prior To Sex Place : Familiar Place, Partner Prolonged Foreplay Position: Any Comfortable Position OLD: Side Lying M O N A T Substances to Avoid with Anticoagulants: d. If longer than 80 secondsdosage should be lowered. e. If less than 60 secondsdosage should be increased. Hospital use- heparin Maintenance use- warfarin Management: Warfarin does not take effect immediately Only after 3 days Blood levels The normal PT is 9.6 to 11.8 seconds. Warfarin sodium prolongs the PT; the therapeutic range is 1.5 to 2 times the control value. If the INR is below the recommended range, warfarin sodium should be increased. If the INR is above the recommended range, warfarin sodium should be reduced.

Antiplatelet Medications Abciximab (ReoPro) Aspirin (acetylsalicylic acid, ASA) Cilostazol (Pletal) Clopidogrel (Plavix) ,Dipyridamole (Persantine) , Dipyridamole; aspirin (Aggrenox) Eptifibatide (Integrilin) Ticlopidine (Ticlid) Tirofiban (Aggrastat) HEART FAILURE 1. inability of the heart to maintain adequate cardiac output to meet the metabolic needs of the body because of impaired pumping ability. 2. Diminished cardiac output results in inadequate peripheral tissue perfusion. 3. Congestion of the lungs and periphery may occur. Cardiac glycosides Diuretics Antihypertensive Arterial Disorders TAO (Thromboangitis Obliterans) Unknown Etiology (CC: Smoking) ASO (Atherosclerosis Obliterans) Inflammation of Arteries Due To Fat Buerger's disease (thromboangiitis obliterans) TAO Unknown: smoking occlusive disease of the median and small arteries and veins. The distal upper and lower limbs are affected most commonly. ARTERIAL DISORDERS Peripheral arterial disease a. Chronic disorder in which partial or total arterial occlusion deprives the lower extremities of oxygen and nutrients b. Tissue damage occurs below the level of the arterial occlusion. c. Atherosclerosis is the most common cause of peripheral arterial disease. ASO (Atherosclerosis Obliterans) Inflammation of Arteries Due To Fat Assessment 6 ps Pain (Intermittent claudication) * Ischemic pain occurring in the digits while at rest Aching pain that is more severe at night or at rest relieved by placing the extremity in a dependent position Lower back or buttock discomfort Pulselessness- diminished at distal area Paresthesia Poikilothermia Pallor (gray-blue color ) elevation pallor with dependent rubor (red in the dependent position) Paralysis Arterial Ulcer formation- at distal Loss of hair and dry scaly skin on the lower extremities Thickened toenails

BP measurements at the thigh, calf, and ankle lower than the brachial pressure (normally, BP readings in the thigh and calf are higher than those in the upper extremities). Raynaud's disease a. vasospasms of the arterioles and arteries of the upper and lower extremities. b. Vasospasm causes constriction of the cutaneous vessels. c. Attacks are intermittent and occur with exposure to cold or stress. d. Affects primarily fingers, toes, ears, and cheeks Assessment a. Blanching of the extremity, followed by cyanosis during vasoconstriction b. Reddened tissue when the vasospasm is relieved Pallor -> cyanosis -> rubor c. 6 ps Nursing Intervention (PULSES) Promote Adequate Tissue Perfusion on the Leg of the Patient. Pulse Checking on Both Legs Discrepancy = Problem Measure the circumference on the thighs Asymmetry = Problem Position the leg of the patient flat on bed. Elevate below heart level: clients with edema may sleep with the affected limb hanging from the bed or they may sit upright in a chair for comfort. U Understand the Medications of the Client. Pentoxifylline DOC for Intermittent Claudication Papaverine Vasodilator Isoxuprine (Vasodilan) Vasodilator Cilostazol Anti Platelet / Anti Thrombotic / L-Carnitine Increases Oxygenation of Cells L Low Fat Diet S Safety on the Legs of the Patient stop Smoking stop Exposure to Cold no crossing of legs never apply heat directly to legs Wear white cotton socks (change daily) Wear Leather Shoes (Better Support Less Moisture Formation) Skin care E Exercise Buerger Allen Exercise S Surgery Femoral Popliteal Bypass Graft Vascular disorders Venous thrombosis a. Thrombophlebitis: Thrombus associated with

Vasodilator

inflammation b. Phlebothrombus: Thrombus without inflammation c. Phlebitis: Vein inflammation associated with invasive procedures, such as IV lines d. Deep vein thrombophlebitis: More serious than a superficial thrombophlebitis because of the risk for pulmonary embolism Thrombophlebitis , DVT Virchows Triad Venous Stasis Endothelial Injury Increased Blood Viscosity Hallmark Sign: (+) Homans Sign Intervention: V

Venous Support (JOBST Stockings) JOBST = Pre-filled Pressure

Intermittent Compression Devices (anti embolism stockings) Improves Circulation on Legs Rest [ Do Not Massage Leg] no gatch or pillow under knee Count on Elevating the Leg (above heart level) H20 Intake Increase Observe Anti Coagulant Treatment

C H O

W Warm Moist Application Phlebitis Assessment a. Red, warm area radiating up the vein and extremity b. Pain and soreness c. Swelling Interventions a. warm moist soaks as prescribed to dilate the vein and promote circulation (assess temperature of soak before applying). Varicose veins Vein walls weaken and dilate, and valves become incompetent. Assessment a. Pain in the legs with dull aching after standing b. A feeling of fullness in the legs c. Ankle edema d. darkened and tortuous veins e. Trendelenburg's test

Place the client in a supine position with the legs elevated. When the client sits up, if varicosities are present, veins fill from the proximal end; veins normally fill from the distal end. Management: same with veinous probem Surgery: Stripping / Sclerotherapy (Na Morrhuate) > Hardens Blood Vessels Venous insufficiency results from prolonged venous hypertension, which stretches the veins and damages the valves Assessment a. Stasis dermatitis or brown discoloration along the ankles, extending up to the calf b. Edema c. Ulcer formation: side of legs: Edges are uneven, ulcer bed is pink, and granulation is present. Intervention: V Venous Congestion Reduction avoid prolonged sitting or standing, constrictive clothing, crossing legs when seated. E Elevate legs as much as possible above the level of the heart when in bed. elevate the legs for 10 to 20 minutes every few hours each day. Note Color Changes Brown Discoloration of Leg Observe Hose Application

O U

Ulcer Treatment Unna Paste Boot (Zinc Oxide) compression system is applied over a dressing. S- stockings (elastic / compression / pneumatic) instruct the client to put on clean stockings on awakening, before getting out of bed). 1 hour in morning and 1 hour at night. probably for life