Central venous catheters devices Major surgery Venous foot pumps Abdominal aortic Often asymptomatic Abdominal imaging (X-rays) Monitor growth with aneurysms and Pain with gnawing quality, CT – size and location abdominal US q6 months dissection unaffected by movement, lasts Aortic angiography Maintain normal BP - meds for hours/days Abdominal US Smoking cessation Dissection Pain in abdomen, flank, back Abdominal angiography Control of fasting lipid Life-threatening, tear Pulsatile abdominal mass MRA D/C steroids in the lumen AAA >3cm in diameter Endovascular stent graft Diminished blood Surgical repair, endovascular supply distal to repair dissection Monitor S?S of impending rupture: Restlessness Abdominal pain, tenderness Prep for emergent sx Post-op care: Risk factor reduction Wound care Activity restriction Medication regime Reportable symptoms Meds if <5.5 cm Heart Failure HTN Activity intolerance LV systolic dysfunction: Cool forearms and legs CAD Fluid retention Volume overload Assess response to diuresis Neurohormonal Dilated cardiomyopathy SOB Decreased contractility Assess CO response Hyperlipidemia Fatigue LVEF < 40% to 45% Monitor I&O SNS activation Metabolic syndrome L-sided: fatigue, activity Monitor for dysrhythmias RAAS activation – Obesity intolerance, SOB, cough, Diastolic Dysfunction Encourage increasing levels of sodium and fluid Sedentary lifestyle orthopnea, paroxysmal HF with normal LVEF activity retention, myocardial Smoking nocturnal dyspnea Slow relaxation Perform ADLs hypertrophy Valvular abnormalities R-sided: abdominal bloating and HTN, DM, obesity, a-fib Patient knowledge of dx Cardiac remodeling Age discomfort, poor appetite, Reduced stroke volume O2 sat – administer O2 Family hx of CAD nausea Stiff heart Assess temperature Exacerbation and Gender Bivent: combination of L and R Assess for cyanosis stabilization Genes CBC – anemia, liver/renal Assess neuro status Confusion, forgetfulness, loss of BNP – LV stretch, high Auscultate concentration, disorientation High microalbumin Cardiac cachexia Electrolytes & Cr Meds JVD Liver function test Cardiac devices Crackles Urinalysis Control comorbidities
Central venous catheters Major surgery devices Venous foot pumps Abdominal aortic aneurysms and dissection Dissection Life-threatening, tear in the lumen Diminished blood supply distal to dissection Often asymptomatic Pain with gnawing quality, unaffected by movement, lasts for hours/days Pain in abdomen, flank, back Pulsatile abdominal mass Abdominal imaging (X-rays) CT – size and location Aortic angiography Abdominal US Abdominal angiography MRA AAA >3cm in diameter Monitor growth with abdominal US q6 months Maintain normal BP - meds Smoking cessation Control of fasting lipid D/C steroids Endovascular stent graft Surgical repair, endovascular repair Monitor S?S of impending rupture: Restlessness Abdominal pain, tenderness Prep for emergent sx Post-op care: Risk factor reduction Wound care Activity restriction Medication regime Reportable symptoms Meds if <5.5 cm Heart Failure Neurohormonal response SNS activation RAAS activation – sodium and fluid retention, myocardial hypertrophy Cardiac remodeling Exacerbation and stabilization HTN CAD Dilated cardiomyopathy Hyperlipidemia Metabolic syndrome Obesity Sedentary lifestyle Smoking Valvular abnormalities Age Family hx of CAD Gender Genes Activity intolerance Fluid retention SOB Fatigue L-sided: fatigue, activity intolerance, SOB, cough, orthopnea, paroxysmal nocturnal dyspnea R-sided: abdominal bloating and discomfort, poor appetite, nausea Bivent: combination of L and R Confusion, forgetfulness, loss of concentration, disorientation Cardiac cachexia JVD Crackles LV systolic dysfunction: Volume overload Decreased contractility LVEF < 40% to 45% Diastolic Dysfunction HF with normal LVEF Slow relaxation HTN, DM, obesity, a-fib Reduced stroke volume Stiff heart CBC – anemia, liver/renal BNP – LV stretch, high High microalbumin Electrolytes & Cr Liver function test Urinalysis Cool forearms and legs Assess response to diuresis Assess CO Monitor I&O Monitor for dysrhythmias Encourage increasing levels of activity Perform ADLs Patient knowledge of dx O2 sat – administer O2 Assess temperature Assess for cyanosis Assess neuro status Auscultate Meds Cardiac devices Control comorbidities