Cardiovascular & Hematologic System

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Information about Cardiovascular & Hematologic System

Published on October 25, 2007

Author: nclexvideos

Source: slideshare.net

Description

Cardiovascular & Hematologic System

CARDIOLOGY NURSING

THE CARDIOVASCULAR SYSTEM HEART’S NORMAL ANATOMY The heart is located in the LEFT side of the mediastinum Consists of Three layers - epicardium, myocardium and endocardium

HEART’S NORMAL ANATOMY

The heart is located in the LEFT side of the mediastinum

Consists of Three layers - epicardium, myocardium and endocardium

THE CARDIOVASCULAR SYSTEM The epicardium covers the outer surface of the heart The myocardium is the middle muscular layer of the heart The endocardium lines the chambers and the valves

The epicardium covers the outer surface of the heart

The myocardium is the middle muscular layer of the heart

The endocardium lines the chambers and the valves

THE CARDIOVASCULAR SYSTEM The layer that covers the heart is the PERICARDIUM There are two parts - parietal and visceral pericardium The space between the two pericardial layers is the pericardial space

The layer that covers the heart is the PERICARDIUM

There are two parts - parietal and visceral pericardium

The space between the two pericardial layers is the pericardial space

THE CARDIOVASCULAR SYSTEM The heart also has four chambers - two atria and two ventricles The Left atrium and the right atrium The left ventricle and the right ventricle

The heart also has four chambers - two atria and two ventricles

The Left atrium and the right atrium

The left ventricle and the right ventricle

The Cardiovascular System The heart chambers are guarded by valves The atrio-ventricular valves - tricuspid and bicuspid The semi-lunar valves - pulmonic and aortic valves

The heart chambers are guarded by valves

The atrio-ventricular valves - tricuspid and bicuspid

The semi-lunar valves - pulmonic and aortic valves

The Cardiovascular System The Blood supply of the heart comes from the Coronary arteries 1. Right coronary artery supplies the RIGHT atrium and RIGHT ventricle, inferior portion of the LEFT ventricle, the POSTERIOR septal wall and the two nodes - AV (90%) and SA node (55%)

The Blood supply of the heart comes from the Coronary arteries

1. Right coronary artery supplies the RIGHT atrium and RIGHT ventricle, inferior portion of the LEFT ventricle, the POSTERIOR septal wall and the two nodes - AV (90%) and SA node (55%)

The Cardiovascular System 2. Left coronary artery- branches into the LAD and the circumflex branch The LAD supplies blood to the anterior wall of the LEFT ventricle, the anterior septum and the Apex of the left ventricle The CIRCUMFLEX branch supplies the left atrium and the posterior LEFT ventricle

2. Left coronary artery- branches into the LAD and the circumflex branch

The LAD supplies blood to the anterior wall of the LEFT ventricle, the anterior septum and the Apex of the left ventricle

The CIRCUMFLEX branch supplies the left atrium and the posterior LEFT ventricle

 

The Cardiovascular System The CONDUCTING SYSTEM OF THE HEART Consists of the 1. SA node- the pacemaker 2. AV node- slowest conduction 3. Bundle of His – branches into the Right and the Left bundle branch 4. Purkinje fibers- fastest conduction

The CONDUCTING SYSTEM OF THE HEART

Consists of the

1. SA node- the pacemaker

2. AV node- slowest conduction

3. Bundle of His – branches into the Right and the Left bundle branch

4. Purkinje fibers- fastest conduction

 

The Heart sounds 1. S1- due to closure of the AV valves 2. S2- due to the closure of the semi-lunar valves 3. S3- due to increased ventricular filling 4. S4- due to forceful atrial contraction The Cardiovascular System

The Heart sounds

1. S1- due to closure of the AV valves

2. S2- due to the closure of the semi-lunar valves

3. S3- due to increased ventricular filling

4. S4- due to forceful atrial contraction

The Cardiovascular System Heart rate Normal range is 60-100 beats per minute Tachycardia is greater than 100 bpm Bradycardia is less than 60 bpm Sympathetic system INCREASES HR Parasympathetic system (Vagus) DECREASES HR

Heart rate

Normal range is 60-100 beats per minute

Tachycardia is greater than 100 bpm

Bradycardia is less than 60 bpm

Sympathetic system INCREASES HR

Parasympathetic system (Vagus) DECREASES HR

The Cardiovascular System Blood pressure Cardiac output X peripheral resistance Control is neural (central and peripheral) and hormonal Baroreceptors in the carotid and aorta Hormones- ADH, aldosterone, epinephrine can increase BP; ANF can decrease BP

Blood pressure

Cardiac output X peripheral resistance

Control is neural (central and peripheral) and hormonal

Baroreceptors in the carotid and aorta

Hormones- ADH, aldosterone, epinephrine can increase BP; ANF can decrease BP

The Cardiovascular System The vascular system consists of the arteries, veins and capillaries The arteries are vessels that carry blood away from the heart to the periphery The veins are the vessels that carry blood to the heart The capillaries are lined with squamos cells, they connect the veins and arteries

The vascular system consists of the arteries, veins and capillaries

The arteries are vessels that carry blood away from the heart to the periphery

The veins are the vessels that carry blood to the heart

The capillaries are lined with squamos cells, they connect the veins and arteries

The Cardiovascular System The lymphatic system also is part of the vascular system and the function of this system is to collect the extravasated fluid from the tissues and returns it to the blood

The lymphatic system also is part of the vascular system and the function of this system is to collect the extravasated fluid from the tissues and returns it to the blood

The Cardiovascular System Cardiac Assessment

Cardiac Assessment

The Cardiovascular System Laboratory Test Rationale 1. To assist in diagnosing MI 2. To identify abnormalities 3. To assess inflammation

Laboratory Test Rationale

1. To assist in diagnosing MI

2. To identify abnormalities

3. To assess inflammation

The Cardiovascular System Laboratory Test Rationale 4. To determine baseline value 5. To monitor serum level of medications 6. To assess the effects of medications

Laboratory Test Rationale

4. To determine baseline value

5. To monitor serum level of medications

6. To assess the effects of medications

The Cardiovascular System LABORATORY PROCEDURES CARDIAC Proteins and enzymes CK- MB ( creatine kinase) Elevates in MI within 4 hours, peaks in 18 hours and then declines till 3 days

CARDIAC Proteins and enzymes

CK- MB ( creatine kinase)

Elevates in MI within 4 hours, peaks in 18 hours and then declines till 3 days

The Cardiovascular System LABORATORY PROCEDURES CARDIAC Proteins and enzymes CK- MB ( creatine kinase) Normal value is 0-7 U/L

CARDIAC Proteins and enzymes

CK- MB ( creatine kinase)

Normal value is 0-7 U/L

The Cardiovascular System LABORATORY PROCEDURES CARDIAC Proteins and enzymes Lactic Dehydrogenase (LDH) Elevates in MI in 24 hours, peaks in 48-72 hours Normally LDH1 is greater than LDH2

CARDIAC Proteins and enzymes

Lactic Dehydrogenase (LDH)

Elevates in MI in 24 hours, peaks in 48-72 hours

Normally LDH1 is greater than LDH2

The Cardiovascular System LABORATORY PROCEDURES CARDIAC Proteins and enzymes Lactic Dehydrogenase (LDH) MI- LDH2 greater than LDH1 (flipped LDH pattern) Normal value is 70-200 IU/L

CARDIAC Proteins and enzymes

Lactic Dehydrogenase (LDH)

MI- LDH2 greater than LDH1 (flipped LDH pattern)

Normal value is 70-200 IU/L

The Cardiovascular System LABORATORY PROCEDURES CARDIAC Proteins and enzymes Myoglobin Rises within 1-3 hours Peaks in 4-12 hours Returns to normal in a day

CARDIAC Proteins and enzymes

Myoglobin

Rises within 1-3 hours

Peaks in 4-12 hours

Returns to normal in a day

The Cardiovascular System LABORATORY PROCEDURES CARDIAC Proteins and enzymes Myoglobin Not used alone Muscular and RENAL disease can have elevated myoglobin

CARDIAC Proteins and enzymes

Myoglobin

Not used alone

Muscular and RENAL disease can have elevated myoglobin

The Cardiovascular System LABORATORY PROCEDURES Troponin I and T Troponin I is usually utilized for MI Elevates within 3-4 hours, peaks in 4-24 hours and persists for 7 days to 3 weeks! Normal value for Troponin I is less than 0.6 ng/mL

Troponin I and T

Troponin I is usually utilized for MI

Elevates within 3-4 hours, peaks in 4-24 hours and persists for 7 days to 3 weeks!

Normal value for Troponin I is less than 0.6 ng/mL

The Cardiovascular System LABORATORY PROCEDURES Troponin I and T REMEMBER to AVOID IM injections before obtaining blood sample! Early and late diagnosis can be made!

Troponin I and T

REMEMBER to AVOID IM injections before obtaining blood sample!

Early and late diagnosis can be made!

The Cardiovascular System LABORATORY PROCEDURES SERUM LIPIDS Lipid profile measures the serum cholesterol, triglycerides and lipoprotein levels Cholesterol= 200 mg/dL Triglycerides- 40- 150 mg/dL

SERUM LIPIDS

Lipid profile measures the serum cholesterol, triglycerides and lipoprotein levels

Cholesterol= 200 mg/dL

Triglycerides- 40- 150 mg/dL

The Cardiovascular System LABORATORY PROCEDURES SERUM LIPIDS LDH- 130 mg/dL HDL- 30-70- mg/dL NPO post midnight (usually 12 hours)

SERUM LIPIDS

LDH- 130 mg/dL

HDL- 30-70- mg/dL

NPO post midnight (usually 12 hours)

The Cardiovascular System LABORATORY PROCEDURES ELECTROCARDIOGRAM (ECG) A non-invasive procedure that evaluates the electrical activity of the heart Electrodes and wires are attached to the patient

ELECTROCARDIOGRAM (ECG)

A non-invasive procedure that evaluates the electrical activity of the heart

Electrodes and wires are attached to the patient

 

 

The Cardiovascular System LABORATORY PROCEDURES Holter Monitoring A non-invasive test in which the client wears a Holter monitor and an ECG tracing recorded continuously over a period of 24 hours

Holter Monitoring

A non-invasive test in which the client wears a Holter monitor and an ECG tracing recorded continuously over a period of 24 hours

The Cardiovascular System LABORATORY PROCEDURES Holter Monitoring Instruct the client to resume normal activities and maintain a diary of activities and any symptoms that may develop

Holter Monitoring

Instruct the client to resume normal activities and maintain a diary of activities and any symptoms that may develop

 

The Cardiovascular System LABORATORY PROCEDURES ECHOCARDIOGRAM Non-invasive test that studies the structural and functional changes of the heart with the use of ultrasound No special preparation is needed

ECHOCARDIOGRAM

Non-invasive test that studies the structural and functional changes of the heart with the use of ultrasound

No special preparation is needed

 

The Cardiovascular System LABORATORY PROCEDURES Stress Test A non-invasive test that studies the heart during activity and detects and evaluates CAD Exercise test, pharmacologic test and emotional test

Stress Test

A non-invasive test that studies the heart during activity and detects and evaluates CAD

Exercise test, pharmacologic test and emotional test

The Cardiovascular System LABORATORY PROCEDURES Stress Test Treadmill testing is the most commonly used stress test Used to determine CAD, Chest pain causes, drug effects and dysrhythmias in exercise

Stress Test

Treadmill testing is the most commonly used stress test

Used to determine CAD, Chest pain causes, drug effects and dysrhythmias in exercise

The Cardiovascular System LABORATORY PROCEDURES Stress Test Pre-test: consent may be required, adequate rest , eat a light meal or fast for 4 hours and avoid smoking, alcohol and caffeine

Stress Test

Pre-test: consent may be required, adequate rest , eat a light meal or fast for 4 hours and avoid smoking, alcohol and caffeine

The Cardiovascular System LABORATORY PROCEDURES Post-test: instruct client to notify the physician if any chest pain, dizziness or shortness of breath . Instruct client to avoid taking a hot shower for 10-12 hours after the test

Post-test: instruct client to notify the physician if any chest pain, dizziness or shortness of breath . Instruct client to avoid taking a hot shower for 10-12 hours after the test

The Cardiovascular System LABORATORY PROCEDURES Pharmacological stress test Use of dipyridamole Maximally dilates coronary artery Side-effect: flushing of face

Pharmacological stress test

Use of dipyridamole

Maximally dilates coronary artery

Side-effect: flushing of face

The Cardiovascular System LABORATORY PROCEDURES Pharmacological stress test Pre-test: 4 hours fasting, avoid alcohol, caffeine Post test: report symptoms of chest pain

Pharmacological stress test

Pre-test: 4 hours fasting, avoid alcohol, caffeine

Post test: report symptoms of chest pain

The Cardiovascular System LABORATORY PROCEDURES CARDIAC catheterization Insertion of a catheter into the heart and surrounding vessels Determines the structure and performance of the heart valves and surrounding vessels

CARDIAC catheterization

Insertion of a catheter into the heart and surrounding vessels

Determines the structure and performance of the heart valves and surrounding vessels

The Cardiovascular System LABORATORY PROCEDURES CARDIAC catheterization Used to diagnose CAD, assess coronary atery patency and determine extent of atherosclerosis

CARDIAC catheterization

Used to diagnose CAD, assess coronary atery patency and determine extent of atherosclerosis

The Cardiovascular System LABORATORY PROCEDURES Pretest: Ensure Consent, assess for allergy to seafood and iodine, NPO, document weight and height, baseline VS, blood tests and document the peripheral pulses

Pretest: Ensure Consent, assess for allergy to seafood and iodine, NPO, document weight and height, baseline VS, blood tests and document the peripheral pulses

The Cardiovascular System LABORATORY PROCEDURES Pretest: Fast for 8-12 hours, teachings, medications to allay anxiety

Pretest: Fast for 8-12 hours, teachings, medications to allay anxiety

The Cardiovascular System LABORATORY PROCEDURES Intra-test: inform patient of a fluttery feeling as the catheter passes through the heart; inform the patient that a feeling of warmth and metallic taste may occur when dye is administered

Intra-test: inform patient of a fluttery feeling as the catheter passes through the heart; inform the patient that a feeling of warmth and metallic taste may occur when dye is administered

The Cardiovascular System LABORATORY PROCEDURES Post-test: Monitor VS and cardiac rhythm Monitor peripheral pulses, color and warmth and sensation of the extremity distal to insertion site Maintain sandbag to the insertion site if required to maintain pressure Monitor for bleeding and hematoma formation

Post-test: Monitor VS and cardiac rhythm

Monitor peripheral pulses, color and warmth and sensation of the extremity distal to insertion site

Maintain sandbag to the insertion site if required to maintain pressure

Monitor for bleeding and hematoma formation

The Cardiovascular System LABORATORY PROCEDURES Maintain strict bed rest for 6-12 hours Client may turn from side to side but bed should not be elevated more than 30 degrees and legs always straight Encourage fluid intake to flush out the dye Immobilize the arm if the antecubital vein is used Monitor for dye allergy

Maintain strict bed rest for 6-12 hours

Client may turn from side to side but bed should not be elevated more than 30 degrees and legs always straight

Encourage fluid intake to flush out the dye

Immobilize the arm if the antecubital vein is used

Monitor for dye allergy

The Cardiovascular System LABORATORY PROCEDURES CVP The CVP is the pressure within the SVC Reflects the pressure under which blood is returned to the SVC and right atrium

CVP

The CVP is the pressure within the SVC

Reflects the pressure under which blood is returned to the SVC and right atrium

The Cardiovascular System LABORATORY PROCEDURES CVP Normal CVP is 0 to 8 mmHg/ 4-10 cm H2O Elevated CVP indicates increase in blood volume, excessive IVF or heart/renal failure Low CVP may indicated hypovolemia, hemorrhage and severe vasodilatation

CVP

Normal CVP is 0 to 8 mmHg/ 4-10 cm H2O

Elevated CVP indicates increase in blood volume, excessive IVF or heart/renal failure

Low CVP may indicated hypovolemia, hemorrhage and severe vasodilatation

The Cardiovascular System LABORATORY PROCEDURES Measuring CVP 1. Position the client supine with bed elevated at 45 degrees 2. Position the zero point of the CVP line at the level of the right atrium. Usually this is at the MAL, 4 th ICS 3. Instruct the client to be relaxed and avoid coughing and straining.

Measuring CVP

1. Position the client supine with bed elevated at 45 degrees

2. Position the zero point of the CVP line at the level of the right atrium. Usually this is at the MAL, 4 th ICS

3. Instruct the client to be relaxed and avoid coughing and straining.

 

CARDIAC ASSESSMENT ASSESSMENT 1. Health History Obtain description of present illness and the chief complaint Chest pain, SOB, Edema, etc. Assess risk factors

ASSESSMENT

1. Health History

Obtain description of present illness and the chief complaint

Chest pain, SOB, Edema, etc.

Assess risk factors

CARDIAC ASSESSMENT 2. Physical examination Vital signs- BP, PP, MAP Inspection of the skin Inspection of the thorax Palpation of the PMI, pulses Auscultation of the heart sounds

2. Physical examination

Vital signs- BP, PP, MAP

Inspection of the skin

Inspection of the thorax

Palpation of the PMI, pulses

Auscultation of the heart sounds

 

CARDIAC ASSESSMENT 3. Laboratory and diagnostic studies CBC cardiac catheterization Lipid profile arteriography Cardiac enzymes and proteins CXR CVP EEG Holter monitoring Exercise ECG

3. Laboratory and diagnostic studies

CBC

cardiac catheterization

Lipid profile

arteriography

Cardiac enzymes and proteins

CXR

CVP

EEG

Holter monitoring

Exercise ECG

CARDIAC IMPLEMENTATION Assess the cardio-pulmonary status VS, BP, Cardiac assessment 2. Enhance cardiac output Establish IV line to administer fluids

Assess the cardio-pulmonary status

VS, BP, Cardiac assessment

2. Enhance cardiac output

Establish IV line to administer fluids

CARDIAC IMPLEMENTATION 3. Promote gas exchange Administer O2 Position client in SEMI-Fowler’s Encourage coughing and deep breathing exercises

3. Promote gas exchange

Administer O2

Position client in SEMI-Fowler’s

Encourage coughing and deep breathing exercises

CARDIAC IMPLEMENTATION 4. Increase client activity tolerance Balance rest and activity periods Assist in daily activities 5. Promote client comfort Assess the client’s description of pain and chest discomfort Administer medication as prescribed

4. Increase client activity tolerance

Balance rest and activity periods

Assist in daily activities

5. Promote client comfort

Assess the client’s description of pain and chest discomfort

Administer medication as prescribed

CARDIAC IMPLEMENTATION 6. Promote adequate sleep 7. Prevent infection Monitor skin integrity of lower extremities Assess skin site for edema, redness and warmth Monitor for fever Change position frequently

6. Promote adequate sleep

7. Prevent infection

Monitor skin integrity of lower extremities

Assess skin site for edema, redness and warmth

Monitor for fever

Change position frequently

CARDIAC IMPLEMENTATION 8. Minimize patient anxiety Encourage verbalization of feelings, fears and concerns Answer client questions. Provide information about procedures and medications

8. Minimize patient anxiety

Encourage verbalization of feelings, fears and concerns

Answer client questions. Provide information about procedures and medications

CARDIAC DISEASES Coronary Artery Disease Myocardial Infarction Congestive Heart Failure Infective Endocarditis Cardiac Tamponade Cardiogenic Shock

Coronary Artery Disease

Myocardial Infarction

Congestive Heart Failure

Infective Endocarditis

Cardiac Tamponade

Cardiogenic Shock

VASCULAR DISEASES Hypertension Buerger’s disease Varicose veins Deep vein thrombosis Aneurysm

Hypertension

Buerger’s disease

Varicose veins

Deep vein thrombosis

Aneurysm

CAD CAD results from the focal narrowing of the large and medium-sized coronary arteries due to deposition of atheromatous plaque in the vessel wall

CAD results from the focal narrowing of the large and medium-sized coronary arteries due to deposition of atheromatous plaque in the vessel wall

CAD RISK FACTORS 1. Age above 45/55 and Sex- Males and post-menopausal females 2. Family History 3. Hypertension 4. DM 5. Smoking 6. Obesity 7. Sedentary lifestyle 8. Hyperlipedimia

RISK FACTORS

1. Age above 45/55 and Sex- Males and post-menopausal females

2. Family History

3. Hypertension

4. DM

5. Smoking

6. Obesity

7. Sedentary lifestyle

8. Hyperlipedimia

CAD RISK FACTORS Most important MODIFIABLE factors: Smoking Hypertension Diabetes Cholesterol abnormalities

RISK FACTORS

Most important MODIFIABLE factors:

Smoking

Hypertension

Diabetes

Cholesterol abnormalities

CAD Pathophysiology Fatty streak formation in the vascular intima  T-cells and monocytes ingest lipids in the area of deposition  atheroma  narrowing of the arterial lumen  reduced coronary blood flow  myocardial ischemia

Pathophysiology

Fatty streak formation in the vascular intima  T-cells and monocytes ingest lipids in the area of deposition  atheroma  narrowing of the arterial lumen  reduced coronary blood flow  myocardial ischemia

CAD Pathophysiology There is decreased perfusion of myocardial tissue and inadequate myocardial oxygen supply If 50% of the left coronary arterial lumen is reduced or 75% of the other coronary artery, this becomes significant Potential for Thrombosis and embolism

Pathophysiology

There is decreased perfusion of myocardial tissue and inadequate myocardial oxygen supply

If 50% of the left coronary arterial lumen is reduced or 75% of the other coronary artery, this becomes significant

Potential for Thrombosis and embolism

Angina Pectoris Chest pain resulting from coronary atherosclerosis or myocardial ischemia

Chest pain resulting from coronary atherosclerosis or myocardial ischemia

Angina Pectoris: Clinical Syndromes Three Common Types of ANGINA 1. STABLE ANGINA The typical angina that occurs during exertion, relieved by rest and drugs and the severity does not change

Three Common Types of ANGINA

1. STABLE ANGINA

The typical angina that occurs during exertion, relieved by rest and drugs and the severity does not change

Angina Pectoris: Clinical Syndromes Three Common Types of ANGINA 2. Unstable angina Occurs unpredictably during exertion and emotion, severity increases with time and pain may not be relieved by rest and drug

Three Common Types of ANGINA

2. Unstable angina

Occurs unpredictably during exertion and emotion, severity increases with time and pain may not be relieved by rest and drug

Angina Pectoris: Clinical Syndromes Three Common Types of ANGINA 3. Variant angina Prinzmetal angina, results from coronary artery VASOSPASMS, may occur at rest

Three Common Types of ANGINA

3. Variant angina

Prinzmetal angina, results from coronary artery VASOSPASMS, may occur at rest

Angina Pectoris ASSESSMENT FINDINGS 1. Chest pain- ANGINA The most characteristic symptom PAIN is described as mild to severe retrosternal pain, squeezing , tightness or burning sensation Radiates to the jaw and left arm

ASSESSMENT FINDINGS

1. Chest pain- ANGINA

The most characteristic symptom

PAIN is described as mild to severe retrosternal pain, squeezing , tightness or burning sensation

Radiates to the jaw and left arm

Angina Pectoris ASSESSMENT FINDINGS 1. Chest pain- ANGINA Precipitated by E xercise, E ating heavy meals, E motions like excitement and anxiety and E xtremes of temperature Relieved by REST and Nitroglycerin

ASSESSMENT FINDINGS

1. Chest pain- ANGINA

Precipitated by E xercise, E ating heavy meals, E motions like excitement and anxiety and E xtremes of temperature

Relieved by REST and Nitroglycerin

Angina Pectoris ASSESSMENT FINDINGS 2. Diaphoresis 3. Nausea and vomiting 4. Cold clammy skin 5. Sense of apprehension and doom 6. Dizziness and syncope

ASSESSMENT FINDINGS

2. Diaphoresis

3. Nausea and vomiting

4. Cold clammy skin

5. Sense of apprehension and doom

6. Dizziness and syncope

Angina Pectoris LABORATORY FINDINGS 1. ECG may show normal tracing if patient is pain-free. Ischemic changes may show ST depression and T wave inversion 2. Cardiac catheterization Provides the MOST DEFINITIVE source of diagnosis by showing the presence of the atherosclerotic lesions

LABORATORY FINDINGS

1. ECG may show normal tracing if patient is pain-free. Ischemic changes may show ST depression and T wave inversion

2. Cardiac catheterization

Provides the MOST DEFINITIVE source of diagnosis by showing the presence of the atherosclerotic lesions

Angina Pectoris NURSING MANAGEMENT 1. Administer prescribed medications Nitrates- to dilate the coronary arteries Aspirin- to prevent thrombus formation Beta-blockers- to reduce BP and HR Calcium-channel blockers- to dilate coronary artery and reduce vasospasm

NURSING MANAGEMENT

1. Administer prescribed medications

Nitrates- to dilate the coronary arteries

Aspirin- to prevent thrombus formation

Beta-blockers- to reduce BP and HR

Calcium-channel blockers- to dilate coronary artery and reduce vasospasm

2. Teach the patient management of anginal attacks Advise patient to stop all activities Put one nitroglycerin tablet under the tongue Wait for 5 minutes If not relieved, take another tablet and wait for 5 minutes Another tablet can be taken (third tablet) If unrelieved after THREE tablets  seek medical attention

2. Teach the patient management of anginal attacks

Advise patient to stop all activities

Put one nitroglycerin tablet under the tongue

Wait for 5 minutes

If not relieved, take another tablet and wait for 5 minutes

Another tablet can be taken (third tablet)

If unrelieved after THREE tablets  seek medical attention

Angina Pectoris 3. Obtain a 12-lead ECG 4. Promote myocardial perfusion Instruct patient to maintain bed rest Administer O2 @ 3 lpm Advise to avoid valsalva maneuvers Provide laxatives or high fiber diet to lessen constipation Encourage to avoid increased physical activities

3. Obtain a 12-lead ECG

4. Promote myocardial perfusion

Instruct patient to maintain bed rest

Administer O2 @ 3 lpm

Advise to avoid valsalva maneuvers

Provide laxatives or high fiber diet to lessen constipation

Encourage to avoid increased physical activities

Angina Pectoris 5. Assist in possible treatment modalities PTCA- percutaneous transluminal coronary angioplasty To compress the plaque against the vessel wall, increasing the arterial lumen CABG- coronary artery bypass graft To improve the blood flow to the myocardial tissue

5. Assist in possible treatment modalities

PTCA- percutaneous transluminal coronary angioplasty

To compress the plaque against the vessel wall, increasing the arterial lumen

CABG- coronary artery bypass graft

To improve the blood flow to the myocardial tissue

 

Angina Pectoris 6. Provide information to family members to minimize anxiety and promote family cooperation 7. Assist client to identify risk factors that can be modified 8. Refer patient to proper agencies

6. Provide information to family members to minimize anxiety and promote family cooperation

7. Assist client to identify risk factors that can be modified

8. Refer patient to proper agencies

Myocardial infarction Death of myocardial tissue in regions of the heart with abrupt interruption of coronary blood supply

Death of myocardial tissue in regions of the heart with abrupt interruption of coronary blood supply

 

Myocardial infarction ETIOLOGY and Risk factors 1. CAD 2. Coronary vasospasm 3. Coronary artery occlusion by embolus and thrombus 4. Conditions that decrease perfusion- hemorrhage, shock

ETIOLOGY and Risk factors

1. CAD

2. Coronary vasospasm

3. Coronary artery occlusion by embolus and thrombus

4. Conditions that decrease perfusion- hemorrhage, shock

Myocardial infarction Risk factors 1. Hypercholesterolemia 2. Smoking 3. Hypertension 4. Obesity 5. Stress 6. Sedentary lifestyle

Risk factors

1. Hypercholesterolemia

2. Smoking

3. Hypertension

4. Obesity

5. Stress

6. Sedentary lifestyle

Myocardial infarction PATHOPHYSIOLOGY Interrupted coronary blood flow  myocardial ischemia  anaerobic myocardial metabolism for several hours  myocardial death  depressed cardiac function  triggers autonomic nervous system response  further imbalance of myocardial O2 demand and supply

PATHOPHYSIOLOGY

Interrupted coronary blood flow  myocardial ischemia  anaerobic myocardial metabolism for several hours  myocardial death  depressed cardiac function  triggers autonomic nervous system response  further imbalance of myocardial O2 demand and supply

Myocardial infarction ASSESSMENT findings 1. CHEST PAIN Chest pain is described as severe, persistent, crushing substernal discomfort Radiates to the neck, arm, jaw and back

ASSESSMENT findings

1. CHEST PAIN

Chest pain is described as severe, persistent, crushing substernal discomfort

Radiates to the neck, arm, jaw and back

Myocardial infarction ASSESSMENT findings 1. CHEST PAIN Occurs without cause, primarily early morning NOT relieved by rest or nitroglycerin Lasts 30 minutes or longer

ASSESSMENT findings

1. CHEST PAIN

Occurs without cause, primarily early morning

NOT relieved by rest or nitroglycerin

Lasts 30 minutes or longer

Myocardial infarction Assessment findings 2. Dyspnea 3. Diaphoresis 4. cold clammy skin 5. N/V 6. restlessness, sense of doom 7. tachycardia or bradycardia 8. hypotension 9. S3 and dysrhythmias

Assessment findings

2. Dyspnea

3. Diaphoresis

4. cold clammy skin

5. N/V

6. restlessness, sense of doom

7. tachycardia or bradycardia

8. hypotension

9. S3 and dysrhythmias

Myocardial infarction Laboratory findings 1. ECG- the ST segment is ELEVATED. T wave inversion, presence of Q wave 2. Myocardial enzymes- elevated CK-MB, LDH and Troponin levels 3. CBC- may show elevated WBC count 4. Test after the acute stage- Exercise tolerance test, thallium scans, cardiac catheterization

Laboratory findings

1. ECG- the ST segment is ELEVATED. T wave inversion, presence of Q wave

2. Myocardial enzymes- elevated CK-MB, LDH and Troponin levels

3. CBC- may show elevated WBC count

4. Test after the acute stage- Exercise tolerance test, thallium scans, cardiac catheterization

 

Myocardial infarction Nursing Interventions 1. Provide Oxygen at 2 lpm, Semi-fowler’s 2. Administer medications Morphine to relieve pain nitrates, thrombolytics, aspirin and anticoagulants Stool softener and hypolipidemics 3. Minimize patient anxiety Provide information as to procedures and drug therapy

Nursing Interventions

1. Provide Oxygen at 2 lpm, Semi-fowler’s

2. Administer medications

Morphine to relieve pain

nitrates, thrombolytics, aspirin and anticoagulants

Stool softener and hypolipidemics

3. Minimize patient anxiety

Provide information as to procedures and drug therapy

Myocardial infarction 4. Provide adequate rest periods 5. Minimize metabolic demands Provide soft diet Provide a low-sodium, low cholesterol and low fat diet 6. Minimize anxiety Reassure client and provide information as needed

4. Provide adequate rest periods

5. Minimize metabolic demands

Provide soft diet

Provide a low-sodium, low cholesterol and low fat diet

6. Minimize anxiety

Reassure client and provide information as needed

Myocardial infarction 7. Assist in treatment modalities such as PTCA and CABG 8. Monitor for complications of MI- especially dysrhythmias, since ventricular tachycardia can happen in the first few hours after MI 9. Provide client teaching

7. Assist in treatment modalities such as PTCA and CABG

8. Monitor for complications of MI- especially dysrhythmias, since ventricular tachycardia can happen in the first few hours after MI

9. Provide client teaching

 

MI Medical Management 1. ANALGESIC The choice is MORPHINE It reduces pain and anxiety Relaxes bronchioles to enhance oxygenation

Medical Management

1. ANALGESIC

The choice is MORPHINE

It reduces pain and anxiety

Relaxes bronchioles to enhance oxygenation

MI Medical Management 2. ACE Prevents formation of angiotensin II Limits the area of infarction

Medical Management

2. ACE

Prevents formation of angiotensin II

Limits the area of infarction

MI Medical Management 3. Thrombolytics Streptokinase, Alteplase Dissolve clots in the coronary artery allowing blood to flow

Medical Management

3. Thrombolytics

Streptokinase, Alteplase

Dissolve clots in the coronary artery allowing blood to flow

Myocardial infarction NURSING INTERVENTIONS AFTER ACUTE EPISODE 1. Maintain bed rest for the first 3 days 2. Provide passive ROM exercises 3. Progress with dangling of the feet at side of bed

NURSING INTERVENTIONS AFTER ACUTE EPISODE

1. Maintain bed rest for the first 3 days

2. Provide passive ROM exercises

3. Progress with dangling of the feet at side of bed

Myocardial infarction NURSING INTERVENTIONS AFTER ACUTE EPISODE 4. Proceed with sitting out of bed, on the chair for 30 minutes TID 5. Proceed with ambulation in the room  toilet  hallway TID

NURSING INTERVENTIONS AFTER ACUTE EPISODE

4. Proceed with sitting out of bed, on the chair for 30 minutes TID

5. Proceed with ambulation in the room  toilet  hallway TID

Myocardial infarction NURSING INTERVENTIONS AFTER ACUTE EPISODE Cardiac rehabilitation To extend and improve quality of life Physical conditioning Patients who are able to walk 3-4 mph are usually ready to resume sexual activities

NURSING INTERVENTIONS AFTER ACUTE EPISODE

Cardiac rehabilitation

To extend and improve quality of life

Physical conditioning

Patients who are able to walk 3-4 mph are usually ready to resume sexual activities

CARDIOMYOPATHIES Heart muscle disease associated with cardiac dysfunction

Heart muscle disease associated with cardiac dysfunction

CARDIOMYOPATHIES 1. Dilated Cardiomyopathy 2. Hypertrophic Cardiomyopathy 3. Restrictive cardiomyopathy

1. Dilated Cardiomyopathy

2. Hypertrophic Cardiomyopathy

3. Restrictive cardiomyopathy

DILATED CARDIOMYOPATHY ASSOCIATED FACTORS 1. Heavy alcohol intake 2. Pregnancy 3. Viral infection 4. Idiopathic

ASSOCIATED FACTORS

1. Heavy alcohol intake

2. Pregnancy

3. Viral infection

4. Idiopathic

DILATED CARDIOMYOPATHY PATHOPHYSIOLOGY Diminished contractile proteins  poor contraction  decreased blood ejection  increased blood remaining in the ventricle  ventricular stretching and dilatation. SYSTOLIC DYSFUNCTION

PATHOPHYSIOLOGY

Diminished contractile proteins  poor contraction  decreased blood ejection  increased blood remaining in the ventricle  ventricular stretching and dilatation.

SYSTOLIC DYSFUNCTION

HYPERTROPHIC CARDIOMYOPATHY Associated factors: 1. Genetic 2. Idiopathic

Associated factors:

1. Genetic

2. Idiopathic

HYPERTROPHIC CARDIOMYOPATHY Pathophysiology Increased size of myocardium  reduced ventricular volume  increased resistance to ventricular filling  diastolic dysfunction

Pathophysiology

Increased size of myocardium  reduced ventricular volume  increased resistance to ventricular filling  diastolic dysfunction

RESTRICTIVE CARDIOMYOPATHY Associated factors 1. Infiltrative diseases like AMYLOIDOSIS 2. Idiopathic

Associated factors

1. Infiltrative diseases like AMYLOIDOSIS

2. Idiopathic

RESTRICTIVE CARDIOMYOPATHY Pathophysiology Rigid ventricular wall  impaired stretch and diastolic filling  decreased output Diastolic dysfunction

Pathophysiology

Rigid ventricular wall  impaired stretch and diastolic filling  decreased output

Diastolic dysfunction

CARDIOMYOPATHIES Assessment findings 1. PND 2. Orthopnea 3. Edema 4. Chest pain 5. Palpitations 6. dizziness 7. Syncope with exertion

Assessment findings

1. PND

2. Orthopnea

3. Edema

4. Chest pain

5. Palpitations

6. dizziness

7. Syncope with exertion

CARDIOMYOPATHIES Laboratory Findings 1. CXR- may reveal cardiomegaly 2. ECHOCARDIOGRAM 3. ECG 4. Myocardial Biopsy

Laboratory Findings

1. CXR- may reveal cardiomegaly

2. ECHOCARDIOGRAM

3. ECG

4. Myocardial Biopsy

CARDIOMYOPATHIES Medical Management 1. Surgery 2. pacemaker insertion 3. Pharmacological drugs for symptom relief

Medical Management

1. Surgery

2. pacemaker insertion

3. Pharmacological drugs for symptom relief

CARDIOMYOPATHIES Nursing Management 1.Improve cardiac output Adequate rest Oxygen therapy Low sodium diet

Nursing Management

1.Improve cardiac output

Adequate rest

Oxygen therapy

Low sodium diet

CARDIOMYOPATHIES Nursing Management 2. Increase patient tolerance Schedule activities with rest periods in between

Nursing Management

2. Increase patient tolerance

Schedule activities with rest periods in between

CARDIOMYOPATHIES Nursing Management 3. Reduce patient anxiety Support Offer information about transplantations Support family in anticipatory grieving

Nursing Management

3. Reduce patient anxiety

Support

Offer information about transplantations

Support family in anticipatory grieving

Infective endocarditis Infection of the heart valves and the endothelial surface of the heart Can be acute or chronic

Infection of the heart valves and the endothelial surface of the heart

Can be acute or chronic

Infective endocarditis Etiologic factors 1. Bacteria- Organism depends on several factors 2. Fungi

Etiologic factors

1. Bacteria- Organism depends on several factors

2. Fungi

Infective endocarditis Risk factors 1. Prosthetic valves 2. Congenital malformation 3. Cardiomyopathy 4. IV drug users 5. Valvular dysfunctions

Risk factors

1. Prosthetic valves

2. Congenital malformation

3. Cardiomyopathy

4. IV drug users

5. Valvular dysfunctions

Infective endocarditis Pathophysiology Direct invasion of microbes  microbes adhere to damaged valve surface and proliferate  damage attracts platelets causing clot formation  erosion of valvular leaflets and vegetation can embolize

Pathophysiology

Direct invasion of microbes  microbes adhere to damaged valve surface and proliferate  damage attracts platelets causing clot formation  erosion of valvular leaflets and vegetation can embolize

Infective endocarditis Assessment findings 1. Intermittent HIGH fever 2. anorexia, weight loss 3. cough, back pain and joint pain 4. splinter hemorrhages under nails

Assessment findings

1. Intermittent HIGH fever

2. anorexia, weight loss

3. cough, back pain and joint pain

4. splinter hemorrhages under nails

Infective endocarditis Assessment findings 5. Osler’s nodes- painful nodules on fingerpads 6. Roth’s spots- pale hemorrhages in the retina

Assessment findings

5. Osler’s nodes- painful nodules on fingerpads

6. Roth’s spots- pale hemorrhages in the retina

Infective endocarditis Assessment findings 7. Heart murmurs 8. Heart failure

Assessment findings

7. Heart murmurs

8. Heart failure

Infective endocarditis Prevention Antibiotic prophylaxis if patient is undergoing procedures like dental extractions, bronchoscopy, surgery, etc.

Prevention

Antibiotic prophylaxis if patient is undergoing procedures like dental extractions, bronchoscopy, surgery, etc.

Infective endocarditis LABORATORY EXAM Blood Cultures to determine the exact organism

LABORATORY EXAM

Blood Cultures to determine the exact organism

Infective endocarditis Nursing management 1. regular monitoring of temperature, heart sounds 2. manage infection 3. long-term antibiotic therapy

Nursing management

1. regular monitoring of temperature, heart sounds

2. manage infection

3. long-term antibiotic therapy

Infective endocarditis Medical management 1. Pharmacotherapy IV antibiotic for 2-6 weeks Antifungal agents are given – amphotericin B

Medical management

1. Pharmacotherapy

IV antibiotic for 2-6 weeks

Antifungal agents are given – amphotericin B

Infective endocarditis Medical management 2. Surgery Valvular replacement

Medical management

2. Surgery

Valvular replacement

CHF A syndrome of congestion of both pulmonary and systemic circulation caused by inadequate cardiac function and inadequate cardiac output to meet the metabolic demands of tissues

A syndrome of congestion of both pulmonary and systemic circulation caused by inadequate cardiac function and inadequate cardiac output to meet the metabolic demands of tissues

CHF Inability of the heart to pump sufficiently The heart is unable to maintain adequate circulation to meet the metabolic needs of the body Classified according to the major ventricular dysfunction- Left or Right

Inability of the heart to pump sufficiently

The heart is unable to maintain adequate circulation to meet the metabolic needs of the body

Classified according to the major ventricular dysfunction- Left or Right

 

CHF Etiology of CHF 1. CAD 2. Valvular heart diseases 3. Hypertension 4. MI 5. Cardiomyopathy 6. Lung diseases 7. Post-partum 8. Pericarditis and cardiac tamponade

Etiology of CHF

1. CAD

2. Valvular heart diseases

3. Hypertension

4. MI

5. Cardiomyopathy

6. Lung diseases

7. Post-partum

8. Pericarditis and cardiac tamponade

New York Heart Association Class 1 Ordinary physical activity does NOT cause chest pain and fatigue No pulmonary congestion Asymptomatic NO limitation of ADLs

Class 1

Ordinary physical activity does NOT cause chest pain and fatigue

No pulmonary congestion

Asymptomatic

NO limitation of ADLs

New York Heart Association Class 2 SLIGHT limitation of ADLs NO symptom at rest Symptom with INCREASED activity Basilar crackles and S3

Class 2

SLIGHT limitation of ADLs

NO symptom at rest

Symptom with INCREASED activity

Basilar crackles and S3

New York Heart Association Class 3 Markedly limitation on ADLs Comfortable at rest BUT symptoms present in LESS than ordinary activity

Class 3

Markedly limitation on ADLs

Comfortable at rest BUT symptoms present in LESS than ordinary activity

New York Heart Association Class 4 SYMPTOMS are present at rest

Class 4

SYMPTOMS are present at rest

CHF PATHOPHYSIOLOGY LEFT Ventricular pump failure  back up of blood into the pulmonary veins  increased pulmonary capillary pressure  pulmonary congestion

PATHOPHYSIOLOGY

LEFT Ventricular pump failure  back up of blood into the pulmonary veins  increased pulmonary capillary pressure  pulmonary congestion

CHF PATHOPHYSIOLOGY LEFT ventricular failure  decreased cardiac output  decreased perfusion to the brain, kidney and other tissues  oliguria, dizziness

PATHOPHYSIOLOGY

LEFT ventricular failure  decreased cardiac output  decreased perfusion to the brain, kidney and other tissues  oliguria, dizziness

CHF PATHOPHYSIOLOGY RIGHT ventricular failure  blood pooling in the venous circulation  increased hydrostatic pressure  peripheral edema

PATHOPHYSIOLOGY

RIGHT ventricular failure  blood pooling in the venous circulation  increased hydrostatic pressure  peripheral edema

CHF PATHOPHYSIOLOGY RIGHT ventricular failure  blood pooling  venous congestion in the kidney, liver and GIT

PATHOPHYSIOLOGY

RIGHT ventricular failure  blood pooling  venous congestion in the kidney, liver and GIT

LEFT SIDED CHF ASSESSMENT FINDINGS 1. Dyspnea on exertion 2. PND 3. Orthopnea 4. Pulmonary crackles/rales 5. cough with Pinkish, frothy sputum 6. Tachycardia

1. Dyspnea on exertion

2. PND

3. Orthopnea

4. Pulmonary crackles/rales

5. cough with Pinkish, frothy sputum

6. Tachycardia

LEFT SIDED CHF ASSESSMENT FINDINGS 7. Cool extremities 8. Cyanosis 9. decreased peripheral pulses 10. Fatigue 11. Oliguria 12. signs of cerebral anoxia

7. Cool extremities

8. Cyanosis

9. decreased peripheral pulses

10. Fatigue

11. Oliguria

12. signs of cerebral anoxia

RIGHT SIDED CHF ASSESSMENT FINDINGS 1. Peripheral dependent, pitting edema 2. Weight gain 3. Distended neck vein 4. hepatomegaly 5. Ascites

1. Peripheral dependent, pitting edema

2. Weight gain

3. Distended neck vein

4. hepatomegaly

5. Ascites

RIGHT SIDED CHF ASSESSMENT FINDINGS 6. Body weakness 7. Anorexia, nausea 8. Pulsus alternans

6. Body weakness

7. Anorexia, nausea

8. Pulsus alternans

CHF LABORATORY FINDINGS 1. CXR may reveal cardiomegaly 2. ECG may identify Cardiac hypertrophy 3. Echocardiogram may show hypokinetic heart

LABORATORY FINDINGS

1. CXR may reveal cardiomegaly

2. ECG may identify Cardiac hypertrophy

3. Echocardiogram may show hypokinetic heart

CHF LABORATORY FINDINGS 4. ABG and Pulse oximetry may show decreased O2 saturation 5. PCWP is increased in LEFT sided CHF and CVP is increased in RIGHT sided CHF

LABORATORY FINDINGS

4. ABG and Pulse oximetry may show decreased O2 saturation

5. PCWP is increased in LEFT sided CHF and CVP is increased in RIGHT sided CHF

CHF NURSING INTERVENTIONS 1. Assess patient's cardio-pulmonary status 2. Assess VS, CVP and PCWP. Weigh patient daily to monitor fluid retention

NURSING INTERVENTIONS

1. Assess patient's cardio-pulmonary status

2. Assess VS, CVP and PCWP. Weigh patient daily to monitor fluid retention

CHF NURSING INTERVENTIONS 3. Administer medications- usually cardiac glycosides are given- DIGOXIN or DIGITOXIN, Diuretics, vasodilators and hypolipidemics are prescribed

NURSING INTERVENTIONS

3. Administer medications- usually cardiac glycosides are given- DIGOXIN or DIGITOXIN, Diuretics, vasodilators and hypolipidemics are prescribed

CHF NURSING INTERVENTIONS 4. Provide a LOW sodium diet. Limit fluid intake as necessary 5. Provide adequate rest periods to prevent fatigue

NURSING INTERVENTIONS

4. Provide a LOW sodium diet. Limit fluid intake as necessary

5. Provide adequate rest periods to prevent fatigue

CHF NURSING INTERVENTIONS 6. Position on semi-fowler’s to fowler’s for adequate chest expansion 7. Prevent complications of immobility

NURSING INTERVENTIONS

6. Position on semi-fowler’s to fowler’s for adequate chest expansion

7. Prevent complications of immobility

CHF NURSING INTERVENTION AFTER THE ACUTE STAGE 1. Provide opportunities for verbalization of feelings 2. Instruct the patient about the medication regimen- digitalis, vasodilators and diuretics 3. Instruct to avoid OTC drugs, Stimulants, smoking and alcohol

NURSING INTERVENTION AFTER THE ACUTE STAGE

1. Provide opportunities for verbalization of feelings

2. Instruct the patient about the medication regimen- digitalis, vasodilators and diuretics

3. Instruct to avoid OTC drugs, Stimulants, smoking and alcohol

CHF NURSING INTERVENTION AFTER THE ACUTE STAGE 4. Provide a LOW fat and LOW sodium diet 5. Provide potassium supplements 6. Instruct about fluid restriction

NURSING INTERVENTION AFTER THE ACUTE STAGE

4. Provide a LOW fat and LOW sodium diet

5. Provide potassium supplements

6. Instruct about fluid restriction

CHF NURSING INTERVENTION AFTER THE ACUTE STAGE 7. Provide adequate rest periods and schedule activities 8. Monitor daily weight and report signs of fluid retention

NURSING INTERVENTION AFTER THE ACUTE STAGE

7. Provide adequate rest periods and schedule activities

8. Monitor daily weight and report signs of fluid retention

CARDIOGENIC SHOCK Heart fails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion ETIOLOGY 1. Massive MI 2. Severe CHF 3. Cardiomyopathy 4. Cardiac trauma 5. Cardiac tamponade

Heart fails to pump adequately resulting to a decreased cardiac output and decreased tissue perfusion

ETIOLOGY

1. Massive MI

2. Severe CHF

3. Cardiomyopathy

4. Cardiac trauma

5. Cardiac tamponade

CARDIOGENIC SHOCK ASSESSMENT FINDINGS 1. HYPOTENSION 2. oliguria (less than 30 ml/hour) 3. tachycardia 4. narrow pulse pressure 5. weak peripheral pulses 6. cold clammy skin 7. changes in sensorium/LOC 8. pulmonary congestion

ASSESSMENT FINDINGS

1. HYPOTENSION

2. oliguria (less than 30 ml/hour)

3. tachycardia

4. narrow pulse pressure

5. weak peripheral pulses

6. cold clammy skin

7. changes in sensorium/LOC

8. pulmonary congestion

CARDIOGENIC SHOCK LABORATORY FINDINGS Increased CVP Normal is 4-10 cmH2O

LABORATORY FINDINGS

Increased CVP

Normal is 4-10 cmH2O

CARDIOGENIC SHOCK NURSING INTERVENTIONS 1. Place patient in a modified Trendelenburg (shock ) position 2. Administer IVF, vasopressors and inotropics such as DOPAMINE and DOBUTAMINE 3. Administer O2 4. Morphine is administered to decreased pulmonary congestion and to relieve pain

NURSING INTERVENTIONS

1. Place patient in a modified Trendelenburg (shock ) position

2. Administer IVF, vasopressors and inotropics such as DOPAMINE and DOBUTAMINE

3. Administer O2

4. Morphine is administered to decreased pulmonary congestion and to relieve pain

CARDIOGENIC SHOCK 5. Assist in intubation, mechanical ventilation, PTCA, CABG, insertion of Swan-Ganz cath and IABP 6. Monitor urinary output, BP and pulses 7. cautiously administer diuretics and nitrates

5. Assist in intubation, mechanical ventilation, PTCA, CABG, insertion of Swan-Ganz cath and IABP

6. Monitor urinary output, BP and pulses

7. cautiously administer diuretics and nitrates

CARDIAC TAMPONADE A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)

A condition where the heart is unable to pump blood due to accumulation of fluid in the pericardial sac (pericardial effusion)

CARDIAC TAMPONADE This condition restricts ventricular filling resulting to decreased cardiac output Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac

This condition restricts ventricular filling resulting to decreased cardiac output

Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac

CARDIAC TAMPONADE Causative factors 1. Cardiac trauma 2. Complication of Myocardial infarction 3. Pericarditis 4. Cancer metastasis

Causative factors

1. Cardiac trauma

2. Complication of Myocardial infarction

3. Pericarditis

4. Cancer metastasis

CARDIAC TAMPONADE ASSESSMENT FINDINGS 1. BECK’s Triad- Jugular vein distention, hypotension and distant/muffled heart sound 2. Pulsus paradoxus 3. Increased CVP 4. decreased cardiac output

ASSESSMENT FINDINGS

1. BECK’s Triad- Jugular vein distention, hypotension and distant/muffled heart sound

2. Pulsus paradoxus

3. Increased CVP

4. decreased cardiac output

CARDIAC TAMPONADE ASSESSMENT FINDINGS 5. Syncope 6. anxiety 7. dyspnea 8. Percussion- Flatness across the anterior chest

ASSESSMENT FINDINGS

5. Syncope

6. anxiety

7. dyspnea

8. Percussion- Flatness across the anterior chest

CARDIAC TAMPONADE Laboratory FINDINGS 1. Echocardiogram 2. Chest X-ray

Laboratory FINDINGS

1. Echocardiogram

2. Chest X-ray

CARDIAC TAMPONADE NURSING INTERVENTIONS 1. Assist in PERICARDIOCENTESIS 2. Administer IVF 3. Monitor ECG, urine output and BP 4. Monitor for recurrence of tamponade

NURSING INTERVENTIONS

1. Assist in PERICARDIOCENTESIS

2. Administer IVF

3. Monitor ECG, urine output and BP

4. Monitor for recurrence of tamponade

Pericardiocentesis Patient is monitored by ECG Maintain emergency equipments Elevate head of bed 45-60 degrees Monitor for complications- coronary artery rupture, dysrhythmias, pleural laceration and myocardial trauma

Patient is monitored by ECG

Maintain emergency equipments

Elevate head of bed 45-60 degrees

Monitor for complications- coronary artery rupture, dysrhythmias, pleural laceration and myocardial trauma

HYPERTENSION A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period, based on two or more BP measurements .

A systolic BP greater than 140 mmHg and a diastolic pressure greater than 90 mmHg over a sustained period, based on two or more BP measurements .

HYPERTENSION Types of Hypertension 1. Primary or ESSENTIAL Most common type 2. Secondary Due to other conditions like Pheochromocytoma, renovascular hypertension, Cushing’s, Conn’s , SIADH

Types of Hypertension

1. Primary or ESSENTIAL

Most common type

2. Secondary

Due to other conditions like Pheochromocytoma, renovascular hypertension, Cushing’s, Conn’s , SIADH

HYPERTENSION CLASSIFICATION OF HYPERTENSION by JNC-VII

CLASSIFICATION OF HYPERTENSION by JNC-VII

 

HYPERTENSION PATHOPHYSIOLOGY Multi-factorial etiology BP= CO (SV X HR) x TPR Any increase in the above parameters will increase BP 1. Increased sympathetic activity 2. Increased absorption of Sodium, and water in the kidney

PATHOPHYSIOLOGY

Multi-factorial etiology

BP= CO (SV X HR) x TPR

Any increase in the above parameters will increase BP

1. Increased sympathetic activity

2. Increased absorption of Sodium, and water in the kidney

HYPERTENSION PATHOPHYSIOLOGY Multifactorial etiology BP= CO (SV X HR) x TPR Any increase in the above parameters will increase BP 3. Increased activity of the RAAS 4. Increased vasoconstriction of the peripheral vessels 5. insulin resistance

PATHOPHYSIOLOGY

Multifactorial etiology

BP= CO (SV X HR) x TPR

Any increase in the above parameters will increase BP

3. Increased activity of the RAAS

4. Increased vasoconstriction of the peripheral vessels

5. insulin resistance

HYPERTENSION ASSESSMENT FINDINGS 1. Headache 2. Visual changes 3. chest pain 4. dizziness 5. N/V

ASSESSMENT FINDINGS

1. Headache

2. Visual changes

3. chest pain

4. dizziness

5. N/V

HYPERTENSION Risk factors for Cardiovascular Problems in Hypertensive patients Major Risk factors 1. Smoking 2. Hyperlipidemia 3. DM 4. Age older than 60 5. Gender- Male and post menopausal W 6. Family History

Risk factors for Cardiovascular Problems in Hypertensive patients

Major Risk factors

1. Smoking

2. Hyperlipidemia

3. DM

4. Age older than 60

5. Gender- Male and post menopausal W

6. Family History

HYPERTENSION DIAGNOSTIC STUDIES 1. Health history and PE 2. Routine laboratory- urinalysis, ECG, lipid profile, BUN, serum creatinine , FBS 3. Other lab- CXR, creatinine clearance, 24-huour urine protein

DIAGNOSTIC STUDIES

1. Health history and PE

2. Routine laboratory- urinalysis, ECG, lipid profile, BUN, serum creatinine , FBS

3. Other lab- CXR, creatinine clearance, 24-huour urine protein

HYPERTENSION MEDICAL MANAGEMENT 1. Lifestyle modification 2. Drug therapy 3. Diet therapy

MEDICAL MANAGEMENT

1. Lifestyle modification

2. Drug therapy

3. Diet therapy

HYPERTENSION MEDICAL MANAGEMENT Drug therapy Diuretics Beta blockers Calcium channel blockers ACE inhibitors A2 Receptor blockers Vasodilators

MEDICAL MANAGEMENT

Drug therapy

Diuretics

Beta blockers

Calcium channel blockers

ACE inhibitors

A2 Receptor blockers

Vasodilators

HYPERTENSION NURSING INTERVENTIONS 1. Provide health teaching to patient Teach about the disease process Elaborate on lifestyle changes Assist in meal planning to lose weight

NURSING INTERVENTIONS

1. Provide health teaching to patient

Teach about the disease process

Elaborate on lifestyle changes

Assist in meal planning to lose weight

HYPERTENSION NURSING INTERVENTIONS 1. Provide health teaching to the patient Provide list of LOW fat , LOW sodium diet of less than 2-3 grams of Na/day Limit alcohol intake to 30 ml/day Regular aerobic exercise Advise to completely Stop smoking

NURSING INTERVENTIONS

1. Provide health teaching to the patient

Provide list of LOW fat , LOW sodium diet of less than 2-3 grams of Na/day

Limit alcohol intake to 30 ml/day

Regular aerobic exercise

Advise to completely Stop smoking

HYPERTENSION Nursing Interventions 2. Provide information about anti-hypertensive drugs Instruct proper compliance and not abrupt cessation of drugs even if pt becomes asymptomatic/ improved condition Instruct to avoid over-the-counter drugs that may interfere with the current medication

Nursing Interventions

2. Provide information about anti-hypertensive drugs

Instruct proper compliance and not abrupt cessation of drugs even if pt becomes asymptomatic/ improved condition

Instruct to avoid over-the-counter drugs that may interfere with the current medication

HYPERTENSION Nursing Intervention 3. Promote Home care management Instruct regular monitoring of BP Involve family members in care Instruct regular follow-up 4. Manage hypertensive emergency and urgency properly

Nursing Intervention

3. Promote Home care management

Instruct regular monitoring of BP

Involve family members in care

Instruct regular follow-up

4. Manage hypertensive emergency and urgency properly

Vascular Diseases

ANEURYSM Dilation involving an artery formed at a weak point in the vessel wall

Dilation involving an artery formed at a weak point in the vessel wall

ANEURYSM Saccular= when one side of the vessel is affected Fusiform= when the entire segment becomes dilated

Saccular= when one side of the vessel is affected

Fusiform= when the entire segment becomes dilated

ANEURYSM RISK FACTORS Atherosclerosis Infection= syphilis Connective tissue disorder Genetic disorder= Marfan’s Syndrome

RISK FACTORS

Atherosclerosis

Infection= syphilis

Connective tissue disorder

Genetic disorder= Marfan’s Syndrome

ANEURYSM PATHOPHYSIOLOGY Damage to the intima and media  weakness  outpouching Dissecting aneurysm  tear in the intima and media with dissection of blood through the layers

PATHOPHYSIOLOGY

Damage to the intima and media  weakness  outpouching

Dissecting aneurysm  tear in the intima and media with dissection of blood through the layers

ANEURYSM ASSESSMENT Asymptomatic Pulsatile sensation on the abdomen Palpable bruit

ASSESSMENT

Asymptomatic

Pulsatile sensation on the abdomen

Palpable bruit

ANEURYSM LABORATORY: CT scan Ultrasound X-ray Aortography

LABORATORY:

CT scan

Ultrasound

X-ray

Aortography

ANEURYSM Medical Management: Anti-hypertensives Synthetic graft

Medical Management:

Anti-hypertensives

Synthetic graft

ANEURYSM Nursing Management: Administer medications Emphasize the need to avoid increased abdominal pressure No deep abdominal palpation Remind patient the need for serial ultrasound to detect diameter changes

Nursing Management:

Administer medications

Emphasize the need to avoid increased abdominal pressure

No deep abdominal palpation

Remind patient the need for serial ultrasound to detect diameter changes

PERIPHERAL ARTERIAL OCCLUSIVE DISEASE Refers to arterial insufficiency of the extremities usually secondary to peripheral atherosclerosis. Usually found in males age 50 and above The legs are most often affected

Refers to arterial insufficiency of the extremities usually secondary to peripheral atherosclerosis.

Usually found in males age 50 and above

The legs are most often affected

PERIPHERAL ARTERIAL OCCLUSIVE DISEASE Risk factors for Peripheral Arterial occlusive disease Non-Modifiable 1. Age 2. gender 3. family predisposition

Risk factors for Peripheral Arterial occlusive disease

Non-Modifiable

1. Age

2. gender

3. family predisposition

PERIPHERAL ARTERIAL OCCLUSIVE DISEASE Risk factors for Peripheral Arterial occlusive disease Modifiable 1. Smoking 2. HPN 3. Obesity 4. Sedentary lifestyle 5. DM 6. Stress

Risk factors for Peripheral Arterial occlusive disease

Modifiable

1. Smoking

2. HPN

3. Obesity

4. Sedentary lifestyle

5. DM

6. Stress

PERIPHERAL ARTERIAL OCCLUSIVE DISEASE ASSESSMENT FINDINGS 1. INTERMITTENT CLAUDICATION- the hallmark of PAOD This is PAIN described as aching, cramping or fatiguing discomfort consistently reproduced with the same degree of exercise or activity

ASSESSMENT FINDINGS

1. INTERMITTENT CLAUDICATION- the hallmark of PAOD

This is PAIN described as aching, cramping or fatiguing discomfort consistently reproduced with the same degree of exercise or activity

PERIPHERAL ARTERIAL OCCLUSIVE DISEASE ASSESSMENT FINDINGS 1. INTERMITTENT CLAUDICATION- the hallmark of PAOD This pain is RELIEVED by REST This commonly affects the muscle group below the arterial occlusion

ASSESSMENT FINDINGS

1. INTERMITTENT CLAUDICATION- the hallmark of PAOD

This pain is RELIEVED by REST

This commonly affects the muscle group below the arterial occlusion

PERIPHERAL ARTERIAL OCCLUSIVE DISEASE Assessment Findings 2. Progressive pain on the extremity as the disease advances 3. Sensation of cold and numbness of the extremities

Assessment Findings

2. Progressive pain on the extremity as the disease advances

3. Sensation of cold and numbness of the extremities

PERIPHERAL ARTERIAL OCCLUSIVE DISEASE Assessment Findings 4. Skin is pale when elevated and cyanotic/ruddy when placed on a dependent position 5. Muscle atrophy, leg ulceration and gangrene

Assessment Findings

4. Skin is pale when elevated and cyanotic/ruddy when placed on a dependent position

5. Muscle atrophy, leg ulceration and gangrene

PERIPHERAL ARTERIAL OCCLUSIVE DISEASE Diagnostic Findings 1. Unequal pulses between the extremities 2. Duplex ultrasonography 3. Doppler flow studies

Diagnostic Findings

1. Unequal pulses between the extremities

2. Duplex ultrasonography

3. Doppler flow studies

PAOD Medical Management 1. Drug therapy Pentoxyfylline (Trental) reduces blood viscosity and improves supply of O2 blood to muscles Cilostazol (Pletaal) inhibits platelet aggregation and increases vasodilatation 2. Surgery- Bypass graft and anastomoses

Medical Management

1. Drug therapy

Pentoxyfylline (Trental) reduces blood viscosity and improves supply of O2 blood to muscles

Cilostazol (Pletaal) inhibits platelet aggregation and increases vasodilatation

2. Surgery- Bypass graft and anastomoses

PERIPHERAL ARTERIAL OCCLUSIVE DISEASE Nursing Interventions 1. Maintain Circulation to the extremity Evaluate regularly peripheral pulses, temperature, sensation, motor function and capillary refill time Administer post-operative care to patient who underwent surgery

Nursing Interventions

1. Maintain Circulation to the extremity

Evaluate regularly peripheral pulses, temperature, sensation, motor function and capillary refill time

Administer post-operative care to patient who underwent surgery

PERIPHERAL ARTERIAL OCCLUSIVE DISEASE Nursing Interventions 2. Monitor and manage complications Note for bleeding, hematoma, decreased urine output Elevate the legs to diminish edema Encourage exercise of the extremity while on bed Teach patient to avoid leg-crossing

Nursin

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Search results for: hematologic system cardiovascular. 500 Study Sets 500 Sets 93 Classes 146 Users; Advertisement Upgrade to remove ads
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The Child With a Cardiovascular/Hematologic Disorder ...

Objectives. Describe the cardiovascular and hematologic systems and how they function. Discuss ways the child’s cardiovascular and hematologic system ...
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Hematologic System - Physiology and Pathophysiology of the ...

e The Hematologic System is made up of the Blood, the Spleen, Bone Marrow, and the Liver. Hematology is the study of blood. and all its components. This is ...
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Search › hematology cardiovascular | Quizlet

Hematology & Cardiovascular system. By Loops14 97 terms by Loops14 97 terms Preview Cardiovascular, Immunology ... Hematologic and Cardiovascular System.
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Review of Systems: Integumentary, Hematologic ...

Review of Systems: Integumentary, Hematologic, Cardiovascular, and Pulmonary. ... Review common non-musculoskeletal pathology in the Cardiovascular system.
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Hematologic System - A. Smith's Anatomy & Physiology Page

The hematologic system is all about blood. Blood isn’t just a bunch of cells running around inside the cardiovascular system. It requires many vitamins ...
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Components of the Hematologic System - MCCC

Bio217 Unit VI 2 Leukocytes Evaluation of the Hematologic System •Tests of bone marrow function –Bone marrow aspiration –Bone marrow biopsy
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